THE LIBRARY

OF

THE UNIVERSITY
OF CALIFORNIA

Biology

GIFT OF

Franklin P. Nutting

THE NERVOUS CHILD

PUBLISHED BY THE JOINT COMMITTEE OF

HENRY FROWDE, HODDER & STOUGHTON

17 WARWICK SQUARE, LONDON, E.G. 4

THE

NERVOUS CHILD

BY

HECTOR CHARLES CAMERON

M.A., M.D.(CANTAR.), F.R.C.P.(LOND.)

PHYSICIAN TO GUY'S HOSPITAL AND PHYSICIAN IN CHARGE OF

THE CHILDREN'S DEPARTMENT, GUY'S HOSPITAL

" RESPECT the child. Be not too much his parent.
Trespass not on his solitude." — EMERSON.

LONDON

HENRY FROWDE HODDER & STOUGHTON
OXFORD UNIVERSITY PRESS WARWICK SQUARE, E.G.

1920

First Edition

Second Impression .... igzo

I

PRINTED IN GREAT BRITAIN
BY MORRISON & GIBB LTD., EDINBURGH

I

1*10

GIFT

PREFACE

HP 0-DAY on all sides we hear of the extreme
J- importance of Preventive Medicine and
the great future which lies before us in this aspect
of our work. If so, it follows that the study of
infancy and childhood must rise into corresponding
prominence. More and more a considerable part
of the Profession must busy itself in nurseries and
in schools, seeking to apply there the teachings of
Psychology, Physiology, Heredity, and Hygiene.
To work of this kind, in some of its aspects, this
book may serve as an introduction. It deals with
the influences which mould the mentality of the
child and shape his conduct. Extreme suscepti-
bility to these influences is the mark of the nervous
child.

I have to thank the Editors of The Practitioner
and of The Child, respectively, for permission to
reprint the chapters which deal with " Enuresis "
and "The Nervous Child in Sickness." To Dr.
F. H. Dodd I should also like to offer thanks for
helpful suggestions.

H. C. C.

March 1919.

704

CONTENTS

CHAP. PAG1

I. DOCTORS, MOTHERS, AND CHILDREN . . 1

II. OBSERVATIONS IN THE NURSERY . .16

III. WANT OP APPETITE AND INDIGESTION. . 50

IV. WANT OF SLEEP . . . .64
V. SOME OTHER SIGNS OP NERVOUSNESS . .73

VI. ENURESIS . . . . .89

VII. TOYS, BOOKS, AND AMUSEMENTS . . 96

VIII. NERVOUSNESS IN EARLY INFANCY . .104

IX. MANAGEMENT IN LATER CHILDHOOD . .117

X. NERVOUSNESS IN OLDER CHILDREN . .131

XL NERVOUSNESS AND PHYSIQUE . . .145

XII. THE NERVOUS CHILD IN SICKNESS . .160

XIII. NERVOUS CHILDREN AND EDUCATION ON SEXUAL

MATTERS ..... 169

XIV. THE NERVOUS CHILD AND SCHOOL . .182
INDEX . 191

vii

THE NERVOUS CHILD

CHAPTER I
DOCTORS, MOTHERS, AND CHILDREN

THERE is an old fairy story concerning a pea
which a princess once slept upon — a little
offending pea, a minute disturbance, a trifling
departure from the normal which grew to the pro-
portions of intolerable suffering because of the too
sensitive and undisciplined nervous system of Her
Royal Highness. The story, I think, does not tell
us much else concerning the princess. It does not
tell us, for instance, if she was an only child, the
sole preoccupation of her parents and nurses, sur-
rounded by the most anxious care, reared with some
difficulty because of her extraordinary " delicacy,"
suffering from a variety of illnesses which somehow
always seemed to puzzle the doctors, though some of
the symptoms — the vomiting, for example, and the
high temperature — were very severe and persistent.
Nor does it tell us if later in life, but before the
suffering from the pea arose, she had been taken
to consult two famous doctors, one of whom had
removed the vermiform appendix, while the other
a little later had performed an operation for "ad-

2 THE NERVOUS CHILD

hesions." At any rate, the story with these later
additions, which are at least in keeping with what
we know of her history, would serve to indicate
the importance which attaches to the early training
of childhood. Among the children even of the
well-to-do often enough the hygiene of the mind is
overlooked, and faulty management produces rest-
lessness, instability, and hyper-sensitiveness, which
pass insensibly into neuropathy in adult life.

To prevent so distressing a result is our aim in the
training of children. No doubt the matter concerns
in the first place parents and nurses, school masters
and mistresses, as well as medical men. Yet because
of the certainty that physical disturbances of one
sort or another will follow upon nervous unrest,
it will seldom happen that medical advice will not
be sought sooner or later ; and if the physician is to
intervene with success, he must be prepared with
knowledge of many sorts. He must be prepared
to make a thorough and complete physical examina-
tion, sufficient to exclude the presence of organic
disease. If no organic disease is found, he must
explore the whole environment of the child, and
seek to determine whether the exciting cause is to
be found in the reaction of the child to some form
of faulty management.

For example, a child of two or three years of age
may be brought to the doctor with the complaint
that def aecation is painful, and that there has existed
for some time a most distressing constipation which
has resisted a large number of purgatives of increas-
ing strength. Whenever the child is placed upon the

DOCTORS, MOTHERS, AND CHILDREN 3

stool, his crying at once begins, and no attempts to
soothe or console him have been successful. It is
not sufficient for the doctor in such a case to make
an examination which convinces him that there is
no fissure at the anus and no fistula or thrombosed
pile, and to confine himself to saying that he can
find nothing the matter. The crying and refusal
to go to stool will continue after the visit as before,
and the mother will be apt to conclude that her
doctor, though she has the greatest confidence in
him for the ailments of grown-up persons, is un-
skilled in, or at least not interested in, the diseases
of little children. If, on the other hand, the doctor
pursues his inquiries into the management of the
child in the home, and if, for example, he finds that
the crying and resistance is not confined to going
to stool, but also takes place when the child is put
to bed, and very often at meal-times as well, then
it will be safe for him to conclude that all the symp-
toms are due to the same cause — a sort of " nega-
tivism " which is apt to appear in all children who
are directed and urged too much, and whose parents
are not careful to hide from them the anxiety and
distress which their conduct occasions.

If this diagnosis is made, then a full and clear
explanation should be given to the mother, or at
any rate to such mothers — and fortunately they are
in the majority — who are capable of appreciating
the point of psychology involved, and of correcting
the management of the child so as to overcome the
negativism. To attempt treatment by prescribing
drugs, or in any other way than by correcting the

4 THE NERVOUS CHILD

faulty management, is to court failure. As Charcot
has said, in functional disorders it is not so much
the prescription which matters as the prescriber.

But the task of the doctor is often one of even
greater difficulty. Often enough there will be a
combination of organic disturbance with functional
trouble. For example, a girl of eighteen years old
suffered from a pain in the left arm which has per-
sisted on and off since the olecranon had been
fractured when she was two years of age. She
was the youngest of a large family, and had never
been separated for a day from the care and appre-
hensions of her mother. The joint was stiff, and
there was considerable deformity. The pain always
increased when she was tired or unhappy. Again,
a girl had some slight cystitis with frequent micturi-
tion, and this passed by slow degrees into a purely
functional irritability of the bladder, which called
for micturition at frequent intervals both by day
and night. In such cases treatment must endeavour
to control both factors — the local organic disturb-
ance must if possible be removed, and the faults of
management corrected.

It is a good physician who can appreciate
and estimate accurately the temperament of his
patient, and the need for this insight is nowhere
greater than in dealing with the disorders of child-
hood. It can be acquired only by long practice
and familiarity with children. In the hospital
wards we shall learn much that is essential, but
we shall not learn this. The child, who is so sensi-
sive to his environment, shows but little that is

DOCTORS, MOTHERS, AND CHILDREN 5

characteristic when admitted to an institution.
Only in the nursery can we learn to estimate the
influences which proceed from parents and nurses
of different characters and temperaments, and the
reaction which is produced by them in the child.

The body of the child is moulded and shaped
by the environment in which it grows. Pure air,
a rational diet, free movement, give strength and
symmetry to every part. Faults of hygiene debase
the type, although the type is determined by
heredity which in the individual is beyond our
control. Mothers and nurses to-day are well
aware of the need for a rational hygiene. Mother-
craft is studied zealously and with success, and
there is no lack of books to give sound guidance
and to show the mean between the dangerous
extremes of coddling and a too Spartan exposure.
Yet sometimes it has seemed as if some mothers
whose care for their children's physical health is/
most painstaking, who have nothing to learn orf
the question of diet, of exercise, of fresh air, or o^
baths, who measure and weigh and record with
great minuteness, have had their attention so wholly
occupied with the care of the body that they do
not appreciate the simultaneous growth of the
mind, or inquire after its welfare. Yet it is the
astounding rapidity with which the mental processes
develop that forms the distinguishing characteristic
of the infancy of man. Were it not for this rapid
growth of the cerebral functions, the rearing of
children would be a matter almost as simple and
uneventful as the rearing of live stock. For most

6 THE NERVOUS CHILD

animals faults of environment must be very pro-
nounced to do harm by producing mental unrest
and irritability. Thus, indeed, some wild animal
separated from its fellows and kept in solitary
captivity may sicken and waste, though maintained
and fed with every care. Yet if the whole conditions
of life for the animal are not profoundly altered,
if the environment is natural or approximately
natural, it is as a rule necessary to care only for
its physical needs, and we need not fear that the
results will be spoiled by the reaction of the mind
upon the body. But with the child it is different ;
airy nurseries, big gardens, visits to the seaside,
and every advantage that money can buy cannot
achieve success if the child's mind is not at rest,
if his sleep is broken, if food is habitually retusecl
or vomited, or if to leave him alone in the nursery
for a moment is to evoke a fit of passionate
crying.

The grown-up person comes eventually to be
able to control this tremendous organ, this brain,
which is the predominant feature of his race. In
the child its functions are always unstable and
liable to be upset. Evidence of mental unrest or
fatigue, which is only rarely met with in grown
persons and which then betokens serious disturb-
ance of the mind, is of comparatively common
occurrence in little children. Habit spasm, bed-
wetting, sleep-walking, night terrors, and convulsions
are symptoms which are frequent enough in children,
and there is no need to be unduly alarmed at
their occurrence. In adult age they are found only

DOCTORS, MOTHERS, AND CHILDREN 7

among persons who must be considered as neuro-
pathic. To make the point clear, I have chosen
examples from the graver and more serious symptoms
of nervous unrest. But it is equally true that
minor symptoms which in adults are universally
recognised to be dependent upon cerebral unrest
or fatigue are of everyday occurrence in childhood.
Broken and disturbed sleep, absence of appetite
and persistent refusal of food, gastric pain and
discomfort after meals, nervous vomiting, morbid
flushing and blushing, headache, irritability and
excessive emotional display, at whatever age they
occur, are indications of a mind that is not at rest.
In children, as in adults, they may be prominent
although the physical surroundings of the patient
may be all that could be desired and all that wealth
can procure. It is an everyday experience that
business worries and responsibilities in men, domestic
anxieties or childlessness in women, have the power
to ruin health, even in those who habitually or grossly
break none of its laws. The unstable mind of the
child is so sensitive that cerebral fatigue and irrita-
bility are produced by causes which seem to us
extraordinarily trivial. In the little life which the
child leads, a life in which the whole seems to us
to be comprised in dressing and undressing, washing,
walking, eating, sleeping, and playing, it is not
easy to detect where the elements of nervous
overstrain lie. Nor is it as a rule in these things
that the mischief is to be found. It is in the
personality of mother or nurse, in her conduct to
the child, in her actions and words, in the tone of

8 THE NERVOUS CHILD

her voice when she addresses him, even in the
thoughts which pass through her mind and which
show themselves plainly to that marvellously acute
intuition of his, which divines what she has not
spoken, that we must seek for the disturbing element.
The mental environment of the child is created by
the mother or the nurse. That is her responsibility
and her opportunity. The conduct of the child
must be the criterion of her success. If things go
wrong, if there is constant crying or ungovernable
temper, if sleep and food are persistently refused,
or if there is undue timidity and fearfulness, there
is danger that seeds may be sown from which
nervous disorders will spring in the future.

There are many women who, without any deep
thought on the matter, have the inborn knack of
managing children, who seem to understand them,
and have a feeling for them. With them, we say,
the children are always good, and they are good
because the element of nervous overstrain has not
arisen. There are other women, often very fond
of children, who are conspicuously lacking in this
power. Contact with one of these well-meaning
persons, even for a few days, will demoralise a whole
nursery. Tempers grow wild and unruly, sleep
disappears, fretfulness and irritability take its place.
Yet of most mothers it is probably true that they
are neither strikingly proficient nor utterly deficient
in the power of managing children. If they lack
the gift that comes naturally to some women, they
learn from experience and grow instinctively to
feel when they have made a false step with the

DOCTORS, MOTHERS, AND CHILDREN 9

child. Although by dearly bought experience
they learn wisdom in the management of their chil-
dren, they nevertheless may not study the subject
with the same care which they devote to matters
of diet and hygiene. It is the mother whose educa-
tion and understanding best fits her for this task.
In this country a separate nursery and a separate
nursery life for the children is found in nearly all
households among the well-to-do, and the care for
the physical needs of the children is largely taken
off the mothers' shoulders by nurses and nurse-
maids. That this arrangement is advantageous
on the whole cannot be doubted. In America and
on the Continent, where the children often mingle
all day in the general life of the household, and
occupy the ordinary living rooms, experience
shows that nerve strain and its attendant evils are
more common than with us. Nevertheless, the
arrangement of a separate nursery has its disad-
vantages. Nurses are sometimes not sufficiently
educated to have much appreciation of the mental
processes of the child. If the children are restless
and nervous they are content to attribute this to
naughtiness or to constipation, or to some other
physical ailment. Their time is usually so fully
occupied that they cannot be expected to be very
zealous in reading books on the management of
children. Nevertheless, in practical matters of
detail a good nurse will learn rapidly from a mother
who has given some attention to the subject, and
who is able to give explicit instructions upon definite
points.

10 THE NERVOUS CHILD

It is right that mothers should appreciate the
important part which the environment plays in all
the mental processes of children, and in their physical
condition as well ; that they should understand
that good temper and happiness mean a proper
environment, and that constant crying and fretful-
ness, broken sleep, refusal of food, vomiting, undue
thinness, and extreme timidity often indicate that
something in this direction is at fault.

Nevertheless, we must be careful not to overstate
our case. We must remember how great is the
diversity of temperament in children — a diversity
which is produced purely by hereditary factors.
The task of all mothers is by no means of equal
difficulty. There are children in whom quite gross
faults in training produce but little permanent
damage ; there are others of so sensitive a nervous
organisation that their environment requires the
most delicate adjustment, and when matters have
gone wrong, it may be very difficult to restore
health of mind and body. When a peculiarly
nervous temperament is inherited, wisdom in the
management of the child is essential, and may
sometimes achieve the happiest results. Heredity
is so powerful a factor in the development of the
nervous organisation of the child that, realising its
importance, we should be sparing in our criticism
of the results which the mothers who consult us
achieve in the training of their children. A sensitive,
nervous organisation is often the mark of intellectual
possibilities above the average, and the children
who are cast outside the ordinary mould, who are

DOCTORS, MOTHERS, AND CHILDREN 11

the most wayward, the most intractable, who react
to trifling faults of management with the most
striking symptoms of disturbance, are often those
with the greatest potentialities for achievement
and for good. It is natural for the mother of
placid, contented, and perhaps rather unenterprising
children, looking on as a detached outsider, seeing
nothing of the teeming activities of the quick,
restless little brain, and the persistent, though
faulty reasoning — it is natural for her to blame
another's work, and to flatter herself that her own
routine would have avoided all these troublesome
complications. The mother of the nervous child
may often rightly take comfort in the thought
that her child is worth the extra trouble and the
extra care which he demands, because he is sent
into the world with mechanism which, just because
it is more powerful than the common run, is more
difficult to master and takes longer to control and
to apply for useful ends.

It is through the mother, and by means of her
alone, that the doctor can influence the conduct of
the child. Without her co-operation, or if she
fails to appreciate the whole situation, with the best
will in the world, we are powerless to help. Fortu-
nately with the majority of educated mothers there
is no difficulty. Their powers of observation in
all matters concerning their children are usually
very great. It is their interpretation of what they
have observed that is often faulty. Thus, in the
example given above, the mother observes correctly
that defsecation is inhibited, and produces crying

12 THE NERVOUS CHILD

and resistance. It is her interpretation that the
cause is to be found in pain that is at fault. Again,
a mother may bring her infant for tongue-tie. She
has observed correctly that the child is unable to
sustain the suction necessary for efficient lactation,
and has hit upon this fanciful and traditional ex-
planation. The doctor, who knows that the tongue
takes no part in the act of sucking, will probably
be able to demonstrate that the failure to suck is
due to nasal obstruction, and that the child is forced
to let go the nipple because respiration is impeded.
The opportunities for close observation of the child
which mothers enjoy are so great that we shall not
often be justified in disregarding their statements.
But if we are able to give the true explanation of
the symptoms, it will seldom happen that the
mother will fail to be convinced, because the explana-
tion, if true, will fit accurately with all that has
been observed. Thus the mother of the child in
whom defeecation is inhibited by negativism may
have made further observations. For example,
she may have noted that the so-called constipation
causes fretfulness, that it is almost always bene-
fited by a visit to the country or seaside, or that it
has become much worse since a new nurse, who is
much distressed by it, has taken over the manage-
ment of the child. To this mother the explanation
must be extended to fit these observations, of the
accuracy of which there need be no doubt. Fret-
fulness and negativism with all children whose
management is at fault come in waves and cycles.
The child, naughty and almost unmanageable one

DOCTORS, MOTHERS, AND CHILDREN 13

week, may behave as a model of propriety the
next. The negativism and refusal to go to stool
are the outcome of the nervous unrest, not its cause.
Again, the nervous child, like the adult neuropath,
very often improves for the time being with every
change of scene and surroundings. It is the ennui
and monotony of daily existence, in contact with
the same restricted circle, that becomes insupport-
able and brings into prominence the lack of moral
discipline, the fretfulness, and spirit of opposition.
Lastly, the conduct of the nervous child is deter-
mined to a great extent by suggestions derived
from the grown-up people around him. Refusal of
food, refusal of sleep, refusal to go to stool, as we
shall see later, only become frequent or habitual
when the child's conduct visibly distresses the
nurse or mother, and when the child fully appreciates
the stir which he is creating. The mother will
readily understand that in such a case, where consti-
pation varies in degree according as different persons
take charge of the child, the explanation offered
is that which alone fits with the observed facts.
A full and free discussion between mother and
doctor, repeated it may be more than once, may be
necessary before tlie truth is arrived at, and a line of
action decided upon. Only so can the doctor,
remote as he is from the environment of the
child, intervene to mould its nature and shape its
conduct.

If the doctor is to fit himself to give advice of this
sort, he must be a close observer of little children.
He must not consider it beneath his dignity to study

14 THE NERVOUS CHILD

nursery life and nursery ways. There he will find
the very beginnings of things, the growing point,
as it were, of all neuropathy. A man of fifty, who
in many other ways showed evidence of a highly
nervous temperament, had especially one well-
marked phobia, the fear of falling downstairs. It
had never been absent all his life, and he had grown
used to making the descent of the stairs clinging
firmly to the stair-rail. Family tradition assigned
this infirmity to a fall downstairs in early child-
hood. But all children fall downstairs and are
none the worse. The persistence of the fear was
due, I make no doubt, to the attitude of the
parents or nurse, who made much of the accident,
impressed the occasion strongly on the child's
memory, and surrounded him thereafter with pre-
cautions which sapped his confidence and fanned
his fears.

In what follows we will consider first the subject
of nursery management, searching in it for the
origin of the common disorders of conduct both of
childhood and of later life. I have grouped these
nursery observations under the heads of four char-
acteristic features of the child's psychology — his
Imitativeness, his Suggestibility, his Love of Power,
and his acute though limited Reasoning Faculties.
I feel that some such brief examination is necessary
if we are to understand correctly the aetiology of
some of the most troublesome disorders of child-
hood, such as enuresis, anorexia, dyspepsia, or
constipation, disorders in which the nervous element
is perhaps to-day not sufficiently emphasised

DOCTORS, MOTHERS, AND CHILDREN 15

Finally, we can evolve a kind of nursery psyeho-
therajDeutics — a subject which is not only of
fascinating interest in itself, but which repays
consideration by the success which it brings to our
efforts to cure and control.

CHAPTER II
OBSERVATIONS IN THE NURSERY

(a) THE IMITATIVENESS OF THE CHILD

ris in the second and third years of the child's
life that the rapidity of the development of
the mental processes is most apparent, and it is
with that age that we may begin a closer examina-
tion. At first sight it might seem more reasonable
to adopt a strictly chronological order, and to
start with the infant from the day of his birth.
Since, however, we can only interpret the mind of
the child by our knowledge of our own mental
processes, the study of the older child and of the
later stages is in reality the simpler task. The
younger the infant, the greater the difficulties
become, so that our task is not so much to trace
the development of a process from simple and
early forms to those which are later and more
complex, as to follow a track which is comparatively
plain in later childhood, but grows faint as the
beginnings of life are approached.

At the age, then, of two or three the first quality
of the child which may arrest our attention is his
extreme imitativeness. Not that the imitation
on his part is in any way conscious ; but like a

16 •— -

OBSERVATIONS IN THE NURSERY 17

mirror he reflects in every action and in every
word all that he sees and hears going on around
him. We must recognise that in these early days
his words and actions are not an independent
growth, with roots in his own consciousness, but
are often only the reflection of the words and actions
of others. How completely speech is imitative is
shown by the readiness with which a child contracts
the local accent of his birthplace. The London
parents awake with horror to find their baby an
indubitable Cockney ; the speech of the child bred
beyond the Tweed proclaims him a veritable Scot.
Again, some people are apt to adopt a somewhat
peremptory tone in addressing little children.
Often they do not trouble to give to their voices
that polite or deferential inflection which they
habitually use when speaking to older people.
Listen to a party of nurses in the Park addressing
their charges. As if they knew that their commands
have small chance of being obeyed, they shout
them with incisive force. " Come along at once
when I tell you," they say. And the child faithfully
reflects it all back, and is heard ordering his little
sister about like a drill sergeant, or curtly bidding
his grandmother change her seat to suit his pleasure.
If we are to have pretty phrases and tones of voice,
mothers must see to it that the child habitually
hears no other. Again, mothers will complain that
their child is deaf, or, at any rate, that he has the
bad habit of responding to all remarks addressed
to him by saying, " What ? " or, worse still, " Eh ? "
Often enough the reason that he does so is not
2

18 THE NERVOUS CHILD

that the child is deaf, nor that he is particularly
slow to understand, but simply that he himself
speaks so indistinctly that no matter what he says
to the grown-up people around him, they bend
over him and themselves utter the objectionable
word.

We all hate the tell-tale child, and when a boy
comes in from his walk and has much to say of the
wicked behaviour of his little sister on the after-
noon's outing, his mother is apt to see in this a
most horrid tendency towards tale-bearing and
currying of favour. She does not realise that day
by day, when the children have come in from their
walk, she has asked nurse in their hearing if they have
been good children ; and when, as often happens,
they have not, the nurse has duly recounted their
shortcomings, with the laudable notion of putting
them to shame, and of emphasising to them the
wickedness of their backsliding — and this son of
hers is no hypocrite, but speaks only, as all children
speak, in faithful reproduction of all that he hears.
Those grown-up persons who are in charge of the
children must realise that the child's vocabulary
is their vocabulary, not his own. It is unfortunate,
but I think not unavoidable, that so often almost
the earliest words that the infant learns to speak
are words of reproof, or chiding, or repression.
The baby scolds himself with gusto, uttering
reproof in the very tone of his elders: "No, no,"
"Naughty," or "Dirty," or "Baby shocked."

Speech, then, is imitative from the first, if we
except the early baby sounds with reduplication

OBSERVATIONS IN THE NURSERY 19

of consonants to which in course of time definite
meaning becomes attached, as "Ba-ba," "Ma-ma,"
"Na-na," " Ta-ta," and so forth. Action only
becomes imitative at a somewhat later stage. The
first purposive movements of the child's limbs are
carried out in order to evoke tactile sensations.
He delights to stimulate and develop the sense of
touch. At first he has no knowledge of distance,
and his reach exceeds his grasp. He will strain
to touch and hold distant objects. Gradually he
learns the limitations of space, and will pick up
and hold an object in his hand with precision.
Often he conveys everything to his mouth, not
because his teeth are worrying him, or because he
is hungry, as we hear sometimes alleged, but because
his mouth, lips, and tongue are more sensitive,
because more plentifully furnished with the nerves
of tactile sensation. By constant practice the
sense of touch and the precision of the movement
of his hands are slowly developed, and not these
alone, for the child in acquiring these powers has
developed also the centres in the brain which
control the voluntary movements. When the child
can walk he continues these grasping and touching
exercises in a wider sphere. As the child of fifteen
or eighteen months moves about the room, no
object within his reach is passed by. He stretches
out his hand to touch and seize upon everything,
and to experience the joy of imparting motion to
it. The impulse to develop tactile sensation and pre-
cision in the movements of his hands compels him
with irresistible force. It is foolish to attempt to

20 THE NERVOUS CHILD

repress it. It is foolish, because it is a necessary
phase in his development, and moreover a passing
phase. No doubt it is annoying to his elders while
it lasts, but the only wise course is to try to thwart
as little as we can his legitimate desire to hold and
grasp the objects, and even to assist him in every
way possible. But the mother must assist him
only by allowing free play to his attempts. To
hand him the object is to deprive the exercise of
most of its value. Incidentally she may teach him
the virtue of putting things back in their proper
places, an accomplishment in which he will soon
grow to take a proper pride. If she attempts con-
tinually to turn him from his purpose, reproving
him and snatching things from him, she prolongs
the grasping phase beyond its usual limits. And
she does a worse thing at the same time. Lest the
quicker hands of his nurse should intervene to
snatch the prize away before he has grasped it, he
too learns to snatch, with a sudden clumsy move-
ment that overturns, or breaks, or spills. If left
to himself he will soon acquire the dexterity he
desires. He may overturn objects at first, or let
them fall, but this he regards as failure, which he
soon overcomes. A child of twenty months, whose
development in this particular way has not been
impeded by unwise repression, will pick out the
object on which he has set his heart, play with it,
finger it, and replace it, and he will do it deliberately
and carefully, with a clear desire to avoid mishap.
Dr. Montessori, who has developed into a system the
art of teaching young children to learn precision

OBSERVATIONS IN THE NURSERY 21

of movement and to develop the nerve centres
which control movement, tells in her book a story
which well illustrates this point.1

" The directress of the Casa del Bambini at Milan
constructed under one of the windows a long,
narrow shelf, upon which she placed the little tables
containing the metal geometric forms used in the
first lesson in design. But the shelf was too narrow,
and it often happened that the children in selecting
the pieces which they wished to use would allow one
of the little tables to fall to the floor, thus upsetting
with great noise all the metal pieces which it held.
The directress intended to have the shelf changed,
but the carpenter was slow in coming, and while
waiting for him she discovered that the children
had learned to handle these materials so carefully
that in spite of the narrow and sloping shelf,
the little tables no longer fell to the ground.
The children, by carefully directing their move-
ments, had overcome the defect in this piece of
furniture."

By slow degrees the child learns to command his
movements. If his efforts are aided and not
thwarted, before he is two years old he will have
become capable of conducting himself correctly,
yet with perfect freedom. The worst result of the
continual repression which may be constantly
practised in the mistaken belief that the grasping
phase is a bad habit which persistent opposition
will eradicate, is the nervous unrest and irritation
which it produces in the child. A passionate fit
1 The Montessori Method, pp. 84, 85.

22 THE NERVOUS CHILD

of crying is too often the result of the thwarting
of his nature, and the same process repeated over
and over again, day by day, almost hour by hour,
is apt to leave its mark in unsatisfied longing,
irritability, and unrest. Above all, the child requires
liberty of action.

re have here an admirable example of the effect
of environment in developing the child's powers.
A caged animal is a creature deprived of the stimulus
of environment, and bereft therefore to a great
extent of the skill which we call instinct, by which
it procures its food, guarantees its safety from attack,
constructs its home, cares for its young, and pro-
creates its species. If, metaphorically speaking, we
encircle the child with a cage, if we constantly
intervene to interpose something between him and
the stimulus of his environment, his characteristic
powers are kept in abeyance or retarded, just as
the marvellous instinct of the wild animals becomes
less efficient in captivity.

The grasping phase is but a preliminary to more
complex activities. Just as in schooldays we were
taught with much labour to make pot-hooks and
hangers efficiently before we were promoted to real
attempts at writing, so before the child can really
perform tasks with a definite meaning and purpose,
he must learn to control the finer movements of
his hands. Once the grasping phase, the stage of
pot-hooks, is successfully past — and the end of the
second year in a well-managed child should see its
close — the child sets himself with enthusiasm to
wider tasks. To him washing and dressing, fetching

OBSERVATIONS IN THE NURSERY 23

his shoes and buttoning his gaiters, all the processes
of his simple little life, should be matters of the most
enthralling interest, in which he is eager to take his
part and increasingly capable of doing so. In the
Montessori system there is provided an elaborate
apparatus, the didactic material, designed to cultivate
tactile sensation and the perception of sense stimuli.
It will generally suffice to advise the mother to
make use of the ordinary apparatus of the nursery.
The imitativeness of the young child is so great that
he will repeat in almost every detail all the actions
of his nurse as she carries out the daily routine. At
eighteen months of age, when the electric light is
turned on in his nursery, the child will at once go
to the curtains and make attempts to draw them.
At the same age a little girl will weigh her doll in
her own weighing-machine, will take every precaution
that the nurse takes in her own case, and will even
stoop down anxiously to peer at the dial, just as she
has seen her mother and nurse do on the weekly
weighing night. But at a very early age children
appreciate the difference between the real and the
make-believe. They desire above all things to do
acts of real service. At the age of two a child should
know where every article for the nursery table is
kept. He will fetch the tablecloth and help to put
it in place, spoons and cups and saucers will be carried
carefully to the table, and when the meal is over
he will want to help to clear it all away. All this
is to him a great delight, and the good nurse will
encourage it in the children, because she sees that in
doing so they gain quickness and dexterity and

24 THE NERVOUS CHILD

poise of body. The first purposive movements of
the child should be welcomed and encouraged. It is
foolish and wrong to repress them, as many nurses
do, because the child in his attempts gets in the way,
and no doubt for a time delays rather than expedites
preparations. The child who is made to sit immobile
in his chair while everything is done for him is losing
precious hours of learning and of practice. It is
useless, and to my mind a little distasteful, to
substitute for all this wonderful child activity the
artificial symbolism of the kindergarten school in
which children are taught to sing songs or go through
certain semi-dramatic activities which savour too
much of a performance acquired by precise instruc-
tion. If such accomplishments are desired, they
may be added to, but they must not replace, the
more workaday activities of the little child. The
child whose impulses towards purposive action are
encouraged is generally a happy child, with a mind
at rest. When those impulses are restrained,
mental unrest and irritability are apt to appear,
and toys and picture books and kindergarten games
will not be sufficient to restore his natural peace of
mind.

(6) THE SUGGESTIBILITY OF THE CHILD

We may pass from considering the imitativeness
of the child to study a second and closely related
quality, his suggestibility. His conception of him-
self as a separate individual, of his ego, only gradu-
ally emerges. It is profoundly modified by ideas

OBSERVATIONS IN THE NURSERY 25

derived from those around him. Because of his
lack of acquired experience, there is in the child
an extreme sensitiveness to impressions from
outside. Take, for example, a matter that is some-
times one of great difficulty, the child's likes and
dislikes for food. Many mothers make complaint
that there are innumerable articles of diet which
the child will not take : that he will not drink
milk, or that he will not eat fat, or meat, or vege-
tables, or milk puddings. There are people who
believe that these peculiarities of taste correspond
with idiosyncrasies of digestion, and that children
instinctively turn from what would do them harm.
I do not believe that there is much truth in this
contention. If we watch an infant after weaning,
at the time when his diet is gradually being enlarged
to include more solid food, with new and varied
flavours, we may see his attention arrested by the
strange sensations. With solid or crisp food there
may be a good deal of hesitation and fumbling
before he sets himself to masticate and swallow.
With the unaccustomed flavour of gravy or fruit
juice there may be seen on his face a look of hesita-
tion or surprise. In the stolid and placid child
these manifestations are as a rule but little marked,
and pleasurable sensations clearly predominate.
With children of more nervous temperament it is
clear that sensations of taste are much more acute.
Even in earliest infancy, children have a way of
proclaiming their nervous inheritance by the re-
pugnance which they show to even trifling changes
in the taste or composition of their food. We see

26 THE NERVOUS CHILD

the same sensitiveness in their behaviour to medicines.
The mixture which one child will swallow without
resentment, and almost eagerly, provokes every
expression of disgust from another, or is even
vomited at once. In piloting the child through
this phase, during which he starts nervously at all
unaccustomed sensations and flavours, the attitude
of mother and nurse is of supreme importance.
It is unwise to attempt force ; it is equally unwise,
by excessive coaxing, cajoling, and entreaty, to
concentrate the child's attention on the matter. If
either is tried every meal is apt to become a signal
for struggling and tears. The phase, whether it is
short or long continued, must be accepted as in
the natural order of things, and patience will see
its end. The management of this symptom, —
refusal of food and an apparently complete absence
of desire for food, — which is almost the commonest
neurosis of childhood, will be dealt with later.
Here it is mentioned because I wish to emphasise
that if too much is made of a passing hesitation
over any one article of food, if it becomes the belief
of the mother or nurse that a strong distaste is
present, then if she is not careful her attitude in
offering it, because she is apprehensive of refusal,
will exert a powerful suggestion on the child's mind.
Still worse, it may cause words to be used in the
child's hearing referring to this peculiarity of his.
By frequent repetition it becomes fixed in his mind
that this is part of his own individuality. He
sees himself — and takes great pleasure in the thought
— as a strange child, who by these peculiarities creates

OBSERVATIONS IN THE NURSERY 27

considerable interest in the minds of the grown-up
people around him. When the suggestion takes
root it becomes fixed, and as likely as not it will
persist for his lifetime. It may be habitually said
of a child that, unlike his brothers and sisters, he
will never eat bananas, and thereafter till the day
of his death he may feel it almost a physical im-
possibility to gulp down a morsel of the offending
fruit. So, too, there are people who can bolt their
food with the best of us, who yet declare themselves
incapable of swallowing a pill.

Another example of the force of suggestion,
whether unconscious or openly exercised by speech,
is given us in the matter of sleep. Among adults
the act of going to bed serves as a powerful suggestion
to induce sleep. Seldom do we seek rest so tired
physically that we drop off to sleep from the irre-
sistible force of sheer exhaustion. Yet as soon as
the healthy man whose mind is at peace, whose
nerves are not on edge, finds himself in bed, his eyes
close almost with the force of a hypnotic suggestion,
and he drops off to sleep. With some of us the
suggestion is only powerful in our own bed, that
on which it has acted on unnumbered nights. We
cannot, as we say, sleep in a strange bed. It is
suggestion, not direct will power, that acts. No
one can absolutely will himself to sleep. In insomnia
it is the attempt to replace the unconscious auto-
suggestion by a conscious voluntary effort of will
that causes the difficulty. A thousand times in
the night we resolve that now we will sleep. If we
could but cease to make these fruitless efforts,

28 THE NERVOUS CHILD

sleep might come of itself and the suggestion or
habit be re-established.

In little children the suggestion of sleep, provoked
by being placed in bed, sometimes acts very irregu-
larly. Often it may succeed for a week or two, and
then some untoward happening breaks the habit,
and night after night, for a long time, sleep is refused.
The wakeful child put to bed, resents the process,
and cries and sobs miserably, to the infinite distress
of his mother. It then becomes just as likely that
the child will connect his bed in his mind, not with
rest and sleep, but with sobbing and crying on his
part, and mingled entreaties and scoldings from his
nurse or mother. An important part in this per-
version of the suggestion is played by the attitude
of the person who puts the child to bed. Often the
nurse is uniformly successful, while the mother,
who is perhaps more distressed by the sobbing of
the child, as consistently fails, because she has been
unable to hide her apprehension from him, and has
conveyed to his mind a sense of his own power.

Just in the same way, grown-up people, filled
with anxiety because of the helplessness of the
young child, unable to divest their minds of the
fears of the hundred and one accidents that may
befall, or that within their own experience have
befallen, a little child at one time or another, un-
consciously make unwise suggestions which fill his
mind with apprehension and terror. They do not
like their children to show fear of animals. Nor
would they if it were not that their own appre-
hension that the child may be hurt communicates

OBSERVATIONS IN THE NURSERY 29

itself to him. The child is not of himself afraid to
fall, it is they who suffer the anxiety and show it by
treating the fall as a disaster. The child is not
of himself afraid to be left alone in a room. It is
they who sap his confidence in himself, because
they do not venture to leave him out of their sight,
from a nameless dread of what may happen. A
little girl cut her finger and ran to her nurse, pleased
and interested : " See," she said, seeing it bleed,
" fingers all jammy." Only when the nurse grasped
her with unwise expressions of horror did she break
into cries of fear. A town-bred nurse, who is afraid
of cows, will make every country walk an ordeal of
fear for the children.

Every mother must be made to realise the ease
with which these unconscious suggestions act upon
the mind of the little child, and should school herself
to be strong to make her child strong, and to see to
it that all this suggestive force is utilised for good
and not for evil.

It is upon this susceptibility to suggestion that a
great part of his early education reposes. No one who
is incapable of profiting by this natural disposition
of the child can be successful in her management of
him. Turn where you will in his daily life the
influence of this force of suggestion is clearly ap-
parent. The child does without questioning that
which he is confidently expected to do. Thus he
will eat what is given him, and sleep soundly when
he is put to bed if only the appropriate suggestion
and not the contrary is made to him. Again we
have seen that a perversion of suggestion of this

80 THE NERVOUS CHILD

sort is a common source of constipation in early
childhood. If the child's attention is directed
towards the difficulty, if he is urged or ordered or
appealed to to perform his part, if failure is looked
upon as a serious misfortune, the bowels may remain
obstinately unmoved. In children as in adults a
too great concentration of attention inhibits the
action of the bowels, and constipation, in many
persons, is due to the attempt to substitute will
power for the force of habitual suggestion. No
matter what other treatment we adopt, the mother
must be careful to hide from the child that his
failure is distressing to her. A cheerful optimism
which teaches him to regard himself as one who is
conspicuously regular in his habits, and who has a
reputation in this respect to live up to is sure to
succeed. To talk before him of his habitual consti-
pation, and to worry over the difficulty, is as surely
to fail. In the same way unwise suggestion can
interfere with the passing of water at regular and
suitable intervals. There are children who con-
stantly desire to pass water on any occasion, which
is conspicuously inappropriate, because their atten-
tion has been concentrated on the sensations in
the bladder. Often enough when at great incon-
venience opportunity has been found, the desire
has passed away, and all the trouble has proved
needless. It is not too much to say that every
occupation and every action of the day can be made
delightful or hateful to the child, according to the
suggestion with which it is presented and intro-
duced. Dressing and undressing, eating and drink-

OBSERVATIONS IN THE NURSERY 31

ing, bathing, washing, the putting away of toys,
even going to bed, can be made matters of enthral-
ling interest or delight, or a subject for tears and
opposition, according to the bias which is given to
the child's mind by the words, attitude, and actions
of nurses and mothers.

Here we approach very near to the heart of the
subject. Stripped of all that is not essential we see
the problem of the management of children reduced
to the interplay between the adult mind and the
mind of the receptive suggestible child. That which
is thought of and feared for the child, that he rapidly
becomes. Placid, comfortable people who do not
worry about their children find their children
sensible and easy to manage. Parents who take a
pride in the daring and naughty pranks of their
children unconsciously convey the suggestion to
their minds that such conduct is characteristic of
them. Nervous and apprehensive parents who are
distressed when the child refuses to eat or to sleep,
and who worry all day long over possible sources
of danger to him, are forced to watch their child
acquire a reputation for nervousness, which, as
always, is passively accepted and consistently acted
up to. Differences in type, determined by heredi-
tary factors, no doubt, exist and are often strongly
marked. Yet it is not untrue to say that variations
in children, dependent upon heredity, show chiefly
in the relative susceptibility or insusceptibility of
the child to the influences of environment and
management. It is no easy task to distinguish
between the nervous child and the child of the

32 THE NERVOUS CHILD

nervous mother, between the child who inherits an
unusually sensitive nervous system and the child
who is nervous only because he breathes constantly
an atmosphere charged with doubt and anxiety.

(c) THE CHILD'S LOVE OF POWER

Let us study briefly a third quality of the child
which, for want of a better name, I have called after
the ruling passion of mankind, his love of power.
Perhaps it would be better to call it his love of being
in the centre of the picture. It is his constant
desire to make his environment revolve around him
and to attract all attention to himself. Somewhat
later in life this desire to attract attention, at all
costs, is well seen in the type of girl popularly
regarded as hysterical. The impulse is then a
morbid and debased impulse ; in the child it is
natural and, within limits, praiseworthy. A girl
of this sort, who feels that she is not likely to
attract attention because of any special gifts of
beauty or intellect which she may possess, be-
comes conscious that she can always arouse in-
terest by the severity of her bodily sufferings. The
suggestion acts upon her unstable mind, and forth-
with she becomes paralysed, or a cripple, or dumb,
presenting a mimicry or travesty of some bodily
ailment with which she is more or less familiar.
"Hysterical" girls will even apply caustic to the
skin in order to produce some strange eruption
which, while it sorely puzzles us doctors, will excite
widespread interest and commiseration. Now little

OBSERVATIONS IN THE NURSERY 33

children will seldom carry their desire to attract
attention so far as to work upon the feelings of
their parents by simulating disease. They have not
the necessary knowledge to play the part, and even
if they make the attempt, complaining of this or that
symptom which they notice has aroused the interest
of their elders, the simulation is not likely to be so
successful as to deceive even a superficial observer.
But within the limits of their own powers, children
are past masters in attracting attention. The little
child is unable to take part in any sustained con-
versation ; most of his talking, indeed, is done when
he is alone, and is addressed to no one in particular.
But he knows well that by a given action he can
produce a given reaction in his mother and nurse.
A great part of what is said to him — too great a
part by far — comes under the category of reproof
or repression. He is forbidden to do this or that,
coaxed, cajoled, threatened long before he is old
enough to understand the meaning of the words
spoken, although he knows the tone in which they
are uttered and loves to produce it at will. How
he enjoys it all ! Watch him draw near the fire,
the one place that is forbidden him. He does not
mean to do himself harm. He knows that it is hot
and would hurt him, but for the time being he is out
of the picture and he is intent on producing the
expected response, the reproof tone from his mother
which he knows so well. He approaches it warily,
often anticipating his mother's part and vigorously
scolding himself. He desires nothing more than
that his mother should repeat the reproof, forbidding
3

34 THE NERVOUS CHILD

him a dozen times. The mind of all little children
tends easily to work in a groove. It delights in
repetition and it evoking not the unexpected but
the expected. If his sport is stopped by his mother
losing patience and removing him bodily from the
danger zone, his sense of impotence finds vent in
passionate crying. But if his mother takes no
notice, the sport soon loses its savour. He is
conscious that somehow or other it has fallen flat,
and he flits off to other employment. *

Mothers will complain that children seem to take
a perverse pleasure in evoking reproof, appeals,
entreaties, and exhortations. A small boy of four
who had several times repeated the particular sin
to which his attention had been directed by the
frequency of his mother's warnings and entreaties,
finding that on this occasion she had decided to take
no notice, approached her with a troubled face :
" Are you not angry 1 " he said ; " are you not
disappointed ? " In reality the naughty child is
often only the child who has become master of his
mother's or his nurse's responses, and can produce at
will the effect he desires. The idea that the child
possesses a strong will, which can and must be
broken by persistent opposition, is based upon this
tendency of the child. It is an entire misconception
of the situation. Strength of will and fixity of
purpose are among the last powers which the human
mind develops. In little children they are con-
spicuously absent. What appears to us as a fixed
and persistent desire to perform a definite action in
spite of all we can say or do, is often no more than

OBSERVATIONS IN THE NURSERY 35

the desire to produce the familiar tones of reproof,
to traverse again the familiar ground, to attract
attention and to find himself again the centre of the
picture. If no one pays any attention and no one
reproves, he soon gives up the attempt. If too much
is made of any one action of the child, a strong
impression is made on his mind and he cannot choose
but return to it again and again.

This little drama of the fireplace may teach us a
great deal in the management of children. The
wise mother and nurse will find a hundred devices
to catch the child's attention and lure him away
from the danger zone without the incident making
any impression on his mind at all, and will not call
attention to it by repeated reproofs or warnings which
will certainly lead him straight back to the spot.

In matters of greater moment the same impulse
to oppose the will of those around him is seen. In
considering the point of the child's susceptibility to
suggestion, we have mentioned the refusal of sleep
and the refusal of food. In both it is possible to
detect the influence of this pronounced force of
opposition. As the child lies sobbing or screaming
in bed, every new approach to him, every fresh
attempt at pacification, renews the force of his
opposition in a crescendo of sound. But it is in his
refusal of food that the child is apt to find his chief
opportunity. Meal- times degenerate into a struggle.
There at least he can show his complete mastery of
the situation. No one can swallow his food for him,
and he knows it. He can clench his teeth and shake
his head and obstinately refuse every morsel offered.

36 THE NERVOUS CHILD

He can hold food in his mouth for half an hour at a
time and remain deaf to all the appeals of his helpless
nurse. If she tries force, he quells the attempt by
a storm of crying. If she declines upon entreaty
and coaxing, he will not be persuaded. It is the
little scene of the fireplace over again. The attempts
at force or the attempts at persuasion, by making
much of it, have concentrated the attention of the
child upon the difficulty, and have taught him his
own power to dominate the situation.

It is right that parents should realise that the
disturbing and irritating element in the child's
environment is nearly always provided by the
intrusion of the adult mind and its contact with
the child's. Some supervision and some intrusion,
therefore, is of course absolutely necessary, but the
best-regulated nursery is that in which it is least
evident. Something is definitely wrong if a child
of two years will not play for half an hour at a time
happily and busily in a room by himself. It is an
even better test if the child will play amicably by
himself with nurse or mother in the room, without
the two parties crossing swords on a single occasion,
without reproof or repression on the one side or
undue attempts to attract attention on the other.
If the child is entirely dependent upon the parti-
cipation of grown-up persons in his pursuits, then
not only do those pursuits lose much of their educa-
tive force, but they become a positive source of
danger because of the constant interplay of person-
ality with personality. The child who, seated on the
ground, will play with his toys by himself, rises

OBSERVATIONS IN THE NURSERY 37

with a brain that is stimulated but not exhausted.
Only very rarely do we find that solitary play, or
play between children, is too exciting. In older
children of very quick intelligence and nervous
temperament we occasionally find that the pace
which they themselves set is too exciting or ex-
hausting. I recall a little boy of seven, an only
child of particularly wise and thoughtful parents,
who was brought to me with the complaint that he
exhausted himself utterly both in body and mind
by the intense nervous energy which he threw into
his pursuits. For instance, he had been interested
in the maps illustrating the various fronts in the
European War, with which the walls of his father's
study were hung, and although left entirely by
himself he had become intensely excited and ex-
hausted by the eagerness with which he had spent
a whole morning, with a wealth of imaginative
force, in drawing a map of the garden of his house
and converting it into the likeness of a war map,
filled with imaginary Army Corps. Such excessive
expenditure of nervous force is unusual even in
older children, and as in this case is found usually
only when there is a pronounced nervous inherit-
ance. In little children in the nursery, solitary
play or play between themselves seldom produces
nervous exhaustion. It is quite otherwise when the
child is dependent to a too great extent upon the
participation of adults. It is almost impossible
for the mother and nurse not to take the leading
part in the exchange of ideas, and no matter what
may be their good intentions, the pace set is apt to

38 THE NERVOUS CHILD

be too great. Environment, without the intrusion
of the adult mind, is best able to adjust the necessary
stimulus and produce development without ex-
haustion. Play with grown-up persons, the reading
aloud of story books, the showing of pictures, and
so forth, undoubtedly have their own importance,
but they should be confined within strict limits
and to a definite hour in the daily routine. There
is sometimes too great a tendency for parents to
make playthings of their little children. Save at
stated times, they must curb their desire to join in
their games, to gather them in their arms, to hold
them on their knee, while they stimulate their
minds by a constant succession of new impressions.
With an only child, whose existence is the single
preoccupation of the nurse and mother, and, often
enough, of the father as weD, it is difficult to avoid
this fault. Yet, if wisdom is not learnt, the damage
to the child may be distressingly serious. He
rapidly grows incapable of supporting life without
this excessive stimulation. Without the constant
society and attention of a grown person, he feels
himself lost. He cannot be left alone, and yet
cannot enjoy the society he craves. He grows more
and more restless, dominating the whole situation
more and more, constantly plucking at his nurse's
skirts, perversely refusing every new sensation
that is offered him to still his restlessness for a
moment. The result of all this stimulation is
mental irritability and exhaustion, which in turn is
often the direct cause of refusal of food, dyspepsia,
wakefulness, and excessive crying.

OBSERVATIONS IN THE NURSERY 39

The devices by which children will attract to
themselves the attention of their elders, and which,
if successful, are repeated with an almost insane
persistence, take on the most varied forms. Some-
times the child persistently makes use of an ex-
pression, or asks questions, which produce a pleasant
stir of shocked surprise and renewed reproofs and
expostulations. One little boy shouted the word
" stomachs " with unwearied persistence for many
weeks together. A little girl dismayed her parents
and continued in spite of all they could do to prevent
her to ask every one if they were about to pass
water.

Disorders of conduct of this sort are not really
difficult to control. Suitable punishment will sue
ceed, provided also that the child is deprived of
the sense of satisfaction which he has in the interest
which his conduct excites. His behaviour is only
of importance because it indicates certain faults
in his environment and a certain element of nervous
unrest and overstrain.

The young child demands from his environment
that it should give him two things — security and
liberty. He must have security from shocks to his
nervous system. It is true that from the greater
shocks the children of the well-to-do are as a rule
carefully guarded. No one threatens or ill-uses
them. They are not terrified by drunken brawls
or scenes of passion. They are not made fearful
by the superstitions of ignorant people. Neverthe-
less, by the summation of stimuli little emotions
constantly repeated can have effects no less grave

40 THE NERVOUS CHILD

upon their nervous system. From this constantly
acting irritation the child needs security. In the
second place, he requires liberty to develop his own
initiative, which should be stimulated and sustained
and directed. Without liberty and without security
conduct cannot fail to become abnormal.

(d) THE REASONING POWEB OF THE CHILD

Before we proceed to a closer examination of
the various symptoms of nervous unrest in detail,
we may very briefly consider the scope and power
of the child's understanding. As a rule I am sure
that it is grossly underestimated. The mental
processes of the child are far ahead of his power of
speech. The capacity for understanding speech is
well advanced, and an appeal to reason is often
successful while the child is still powerless to
express his own thoughts in words. Because he
cannot so express himself there is a tendency to
underestimate the acuteness of his reasoning, to
talk down to him, and to imagine that he can be
imposed upon by any fiction which seems likely to
suit the purpose of the moment. A child of eighteen
months is not too young to be talked to in a quiet,
straightforward, sensible way. Only if he is treated
as a reasonable being can we expect his reasoning
faculties to develop. Children dislike intensely
-the unexplained intervention of force. If a pair of
scissors, left by an oversight lying about, has been
grasped, the first impulse of the mother is to snatch
the danger hurriedly from the child's hands, and

OBSERVATIONS IN THE NURSERY 41

her action will generally be followed by resistance
and a storm of weeping. She will do better to
approach, him quietly, telling him that scissors
hurt babies, and show him where to place them
out of harm's way. Watch a child at play after
his midday meal. He has been out in his per-
ambulator half the morning, and for the other half
has been deep in his midday sleep. Now that dinner
is over he is for a moment master of his time and
busily engaged in some pursuit dear to his heart.
At two o'clock inexorable routine ordains that he
must again be placed in the perambulator and
wheeled forth on a fresh expedition. If the nurse
does not know her business she will swoop down
upon him, place him on her knee, and begin to
envelop his struggling little body in his outdoor
clothes, scolding his naughtiness as he kicks and
screams. If she has a way with children she will
open the cupboard door and call on him to help
find his gaiters and his shoes because it is time for
his walk. In a moment he will leave his toys,
forgetting all about them in the joy of this new
activity.

If the reason for things is explained to children
they grow quick to understand quite complicated
explanations. A little girl, not yet two, was play-
ing with her Noah's Ark on the dining-room table
with its polished surface. The mother interposed
a cloth, explaining that the animals would scratch
the table if the cloth were not there. Within a
few minutes the child twice lifted the cloth, peering
under it and saying, "Not scratch table." Yet

42 THE NERVOUS~CHILD

how often do we find facetiously-minded persons
confound their reasoning and confuse their judg-
ment by foolish speeches and cock-and-bull tales,
which, just because of their foolishness, seem to
them well adapted to the infant intelligence.

An attempt to deceive the child is almost always
wrong, and because of our tendency to underestimate
the child's intelligence it generally fails. If a little
girl has a sore throat, and the doctor comes
to see her, she knows quite well that she is the
prospective patient. It is useless for the mother
to begin proceedings by trying to convince her
that this is not so — that mother has a sore throat
too. Such a plan only arouses apprehension,
because the child scents danger in the artifice.

Closely connected with the reasoning powers of
the child is the difficult question of the growth of
his appreciation of right and wrong, or, to put it
in another way, the growth of obedience or dis-
obedience. Sooner or later the child must learn to
obey ; on that there can be no two opinions. Never-
theless, I think there can be no doubt that far
more harm is done by an over-emphasis of authority
than by its neglect. If the nurse or mother is of
strong character, and the authority is exercised
persistently and remorselessly, so that the whole
life of the child is dominated, much as the recruit's
existence in the barrack yard is dominated by the
drill sergeant, his independence of nature is crushed.
He is certain to become a colourless and uninteresting
child ; he runs a grave risk of growing sly, broken-
spirited, and a currier of favour. If a child is ruth-

OBSERVATIONS IN THE NURSERY 43

lessly punished for disobedience from his earliest
years, there is, it need hardly be said, a grave risk
that he will learn to lie to save his skin. I have
seen a few such cases of what I may call the re-
morseless exercise of authority, and the result has
not been pleasing. Fortunately, perhaps, not many
women have the heart to adopt this attitude to the
waywardness of little children — a waywardness to
which their whole nature compels them by their
pressing need to cultivate tactile sensations, to
experiment, and to explore. Therefore, much more
commonly, the authority is exercised intermittently
and capriciously, with the result that the child's
judgment is clouded and confused. Conduct which
is received indulgently or even encouraged at one
moment is sternly reprimanded at another. Every
one who has the management of little children must
above all see to it, whatever the degree of stringency
in discipline which they decide to adopt, that their
attitude is always consistent. T.he less that is
forbidden the better, but when the line is drawn
it must be adhered to. If once the child learns
that the force which restrains him can be made
to yield to his own efforts, the future is black
indeed. From that day he sets himself to strike
down authority with a success which encourages
him to further efforts. I have known a child of
five years terrorise his mother and get his own
way by the threat, " I will go into one of my furies."
The difficulty of successfully enforcing authority,
and of carrying off the victory if that authority is
disputed, should make mothers wary of drawing

44 THE NERVOUS CHILD

too tight a rein. The conflict between parent and
child must always be distressing and must always
be prejudicial to the child, whatever its outcome,
whether it brings to him victory or defeat. He
learns from it either an undue sense of power or
an undue sense of helplessness, and the knowledge
of neither is to his benefit. Although frequently
worsted in the conflict, nurses will often return to
the attack again and again and hour after hour,
restraining,reproving, forbidding, and even threaten-
ing. Nor do they see that they are really goading
the children into disobedience by their misdirected
efforts at enforcing discipline. Reproof, like punish-
ment, loses all its effect when it is too often repeated,
and the child soon takes it for granted that all he
does is wrong, and that grown-up people exist only
to thwart his will, to misunderstand, to reprove, or
even to punish.

In the nursery the word "naughty" is far too
frequently heard. It is naughty to do this, it is
naughty to do that. There is no gradation in the
condemnation, and the child loses all sense of the
meaning of the word. He himself proclaims himself
naughty almost with satisfaction : his doll is naughty,
the dog is naughty, his nurse and mother are
naughty, and so forth. In reality the little child
is peculiarly sensitive to blame, if he is not reproof-
hardened. It is hardly necessary to use words
of blame at all. If he is asked kindly and quietly
to desist, much as we would address a grown-up
person, and does not, he can be made to feel that his
conduct is unpopular by keeping aloof from him a

OBSERVATIONS IN THE NURSERY 45

little, by disregarding him for the time being, and
by indicating to him that he is a troublesome little
person with whom we cannot be bothered.

Any one who has had much to do with children
will realise that, if wrongly handled, they are apt
to take a positive delight in doing what they con-
ceive to be wrong. There is clearly a delightful
element of excitement in the process of being
naughty, of daring and of braving the wrath to
come, with which they are so familiar .and for
which they care nothing at all. But the perverse-
ness of which we are now speaking has a different
origin. It arises only when children are reproved,
appealed to, and expostulated with too often and
too constantly. Negativism is a symptom which is
common enough hi certain mental disorders. The
unhappy patient always does the opposite of what
is desired or expected of him. If he be asked to
stand up he will endeavour to remain seated, or
if asked to sit he will attempt to rise to his feet.
Like many other symptoms of nervous disturbance
which we shall study later, this negativistic spirit
is often displayed to perfection by little children
when the environment is at fault and when grown-
up people have too freely exercised authority. A
mother, anxious to induce her little son to come
to the doctor, and knowing well that her call to him
to enter the room, as he stands hesitating at the
door, will at once determine his retreat to the
nursery, has been heard to say, " Run away,
darling, we don't want you here," with the expected
result that the docile child immediately comes

46 THE NERVOUS CHILD

forward. To the doctor, that such a device should
be practised almost as a matter of course and that
its success should be so confidently anticipated,
should give food for thought. It may shed light
on much that is to follow later in the interview.

The question of punishment, like that of reproof,
is beset with difficulty. There are fortunately
nowadays few educated mothers who are so foolish
as to threaten punishment which they obviously
do not intend to administer and which the child
knows they will not administer. It is clear that
punishment must be rare or else the child will grow
habituated to it, and with little children we cannot
be brutal or push punishment to the point of extreme
physical pain. It is more difficult to say, as one is
tempted to say, that all punishment is futile and
should be discarded. Probably mothers are like
schoolmasters in that no two schoolmasters and no
two mothers obtain their effects in exactly the same
way or by precisely the same means. Nor do all
children accept reproof or submit to punishment
in the same way. Some make light of it and take a
pleasure in defying authority. Others are unduly
cast down by the slightest adverse criticism. It is
generally true that extreme sensitiveness to reproof
is a sign of a certain elevation of character. Always
we must remember that for a mother to inflict
punishment, whether by causing physical pain or
mental suffering, is to take on her shoulders a certain
responsibility. It is a serious matter if she has
misapprehended the child's act — if the sin was not
really a sin, but only some perverted action, the in-

OBSERVATIONS IN THE NURSERY 47

tention of which was not sinful, but designed for
good in the faulty reasoning of the child. A little
girl, in bed with a feverish cold, was found shivering,
with her night-dress wet and muddy. It was an
understanding mother who found that her little
brother, having heard somehow that ice was good for
fevered heads, had brought in several handfuls of
snow from the garden, not of the cleanest, and had
offered them to aid his sister's recovery. It need
hardly be said that punishment should always
be deliberate. The hasty slap is nothing else than
the motor discharge provoked by the irritability of
the educator, and the child, who is a good observer
on such points, discerns the truth and measures the
frailty of his judge.

The frequent repetition of words of reproof and
acts of punishment has a further disadvantage that
the older children are quick to practise both upon
their younger brothers and sisters. There is some-
thing wrong in the nursery where the lives of the
little ones are made a burden to them by the con-
stant repression of the older children. But although
set and artificial punishments are as a general rule
to be used but sparingly, the mother can see to it
that the child learns by experience that a foolish
or careless act brings its own punishment. If,
for example, a child breaks his toy, or destroys its
mechanism, she need not be so quick in mending
it that he does not learn the obvious lesson. If
the baby throws his doll from the perambulator,
in sheer joy at the experience of imparting motion
to it,j3he need not prevent him from learning the

48 THE NERVOUS CHILD

lesson that this involves also some temporary separa-
tion from it. Throughout all his life he is to learn
that he cannot eat his cake and have it too. The
use of rewards is also beset with difficulties. Their
coming must be unexpected and occasional. They
must never degenerate into bribes, to be bargained
for upon condition of good behaviour. Rewards
which take the form of special privileges are best.

The aesthetic sense of children develops very early.
From the very beginning of the second year they
take delight in new clothes, and in personal adorn-
ment of all sorts. They show evident pleasure
if the nursery acquires a new picture or a new
wall-paper. They have pronounced favourites in
colours. Even tiny children show dislike of dirt
and all unpleasant things. Personal cleanliness
should be clearly desired by all children. A sense
of what is pleasant and what is unpleasant should
be encouraged. Any delay in its appearance is
apt to imply a backwardness in development of mind
or of body. Only children who are tired out by
physical illness or by nervous exhaustion will lie
without protest in a dirty condition.

Affection and the attempt to express affection
appear clearly marked even in the first year. Too
much kissing and too much being kissed is apt to
spoil the spontaneity of the child's caresses. We
must not, however, expect to find any trace in the
young child of such a complex quality as unselfish-
ness or self-abnegnation. The child's conception
of his own self has but just emerged. It is his single
impulse to develop his own experience and his own

OBSERVATIONS IN THE NURSERY 49

powers, and his attitude for many years is summed
up in the phrase : " Me do it." We must not
expect him to resign his toys to the little visitor,
or the little visitor to cease from his efforts to obtain
them. In all our dealings with children we must
know what we may legitimately expect from them,
and judge them by their own standards, not by those
of adult life. We cannot expect self-sacrifice in a
child, and, after all, when we come to think of it,
obedience is but another name for self-sacrifice.
If the tiny child could possibly obey all the behests
that are heaped upon him in the course of a day
by many a nurse and mother, he would truly be
living a life of complete self-abnegation. Surely
it is because the virtue of obedience, the virtue that
is proclaimed proverbially the child's own, is so im-
possible of attainment that it is become the subject
of so much emphasis. As Madame Montessori
has put it : " We ask for obedience and the child
in turn asks for the moon." Only when we have
developed the child's reasoning powers, by treating
him as a rational being, can we expect him de-
liberately to defer his wishes to ours, because he has
learned that our requests are generally reasonable.

CHAPTER III
WANT OF APPETITE AND INDIGESTION

THE mind of the child is so unstable and yet
so highly developed, that symptoms of
nervous disturbance are more frequent and of
greater intensity than in later life. Only rarely
and in exceptional cases do certain symptoms,
common in childhood, persist into adult life or
appear there for the first time, and then usually
in persons who, if they are not actually insane,
are at least suffering from intense nervous strain.
We have already mentioned the symptom of nega-
tivism and noted its occasional occurrence as an
accompaniment of mental disorder in adult life,
and its frequency among children who are irritable
or irritated. Similarly, we may cite the digestive
neuroses of adult life to explain the common refusal
of food and the common nervous vomiting of the
second year of life. Thus, for example, there
exists in ad lit life a disturbance of the nervous
system which is called " anorexia nervosa." A
boy of nineteen was brought to the Out-patient
Department of Guy's Hospital suffering from this
complaint. He was little more than a skeleton,
unable to stand, hardly able to sit, and weighing

WANT OF APPETITE AND INDIGESTION 51

only four and a half stones. His mother, who
came with him, stated that he had alwaj^s been
nervous, and that lately, after receiving a call to
join the army as a recruit, his appetite, which had
for some time been capricious, had completely
disappeared. In spite of coaxing he resolutely
refused all food, or took it only in the tiniest morsels,
although at the same time it was thought that
he sometimes took food " on the sly." A careful
examination showed absolutely no sign of bodily
disease. He was admitted to a ward for treatment
by hypnotic suggestion, but before this could be
begun he endeavoured to commit suicide by setting
fire to his bed.

A girl of twenty-four years of age had become
almost equally emaciated. Constant vomiting had
persisted for many years and had defied many
attempts at cure. It had even been proposed to
perform the operation of gastro-enterostomy in
the belief that some organic disease existed. In
suitable surroundings and with the energetic support
of a good nurse, who spent much time and care in
restoring her balance of mind, the vomiting ceased,
and she gained over two stories in weight. Work
was found for her in some occupation connected
with the War, and she left the Nursing Home to
undertake this, bearing with her four pounds which
she had abstracted from the purse of another
patient.

Those who have not opportunities of observ-
ing how all-powerful is the effect of the mind
upon the body, and especially perhaps upon the

52 JTHE NERVOUS CHILD

process of digestion, may find it hard to believe that
these distressing symptoms and profound changes
in the aspect and nutrition of the patients were due
entirely to mental causes and were symptoms in
accord with the attempted suicide or the theft of
the money. In nervous little children we shall
not often find such complex actions as suicide or
theft, although they do occur, but combined with
other evidence of nervousness we shall meet com-
monly enough with a persistent setting aside of
appetite and refusal of food and with continuous
and habitual vomiting, from nervous causes.

The experiments of Pawlow and others have
explained the dependence of digestion upon mental
states. They show that even before the food is
taken into the mouth, while the meal is still in
prospect, there has been instituted a series of changes
in the wall of the stomach, which gives rise to the
so-called psychic secretion of gastric juice. These
changes are preceded by the sensation of appetite,
which is evoked not by the presence of food in the
stomach — for the food has not yet been swallowed
— but by the anticipation of it, by the sight and
smell of food, as well as by more complex sugges-
tions, such as the time of day, the habitual hour}
the approach of home, and so forth.

Emotional states of all sorts — grief, anger, anxiety,
or excitement — put a stop to the process or interfere
with its action, so that the sense of appetite is
absent, and the taking of food is apt to be followed
by discomfort or pain or vomiting. No doubt
good digestion leads to a placid mind, but it is

WANT OF APPETITE AND INDIGESTION 53

equally true that a placid mind is necessary for good
digestion. Therefore we civilised people, living
lives of mental stress and strain, try to increase the
suggestive force of our surroundings and to provoke
appetite by all devices calculated to stimulate the
aesthetic sense. The dinner hour is fixed at a time
when all work and, let us hope, all worry is at
an end for the day. The dinner-table is made as
pretty as possible, with flowers and sparkling glass.
We are wise to dress for dinner, that with our working
clothes we may put off our working thoughts.

In the treatment of adult dyspepsia we seldom
succeed unless we can place the mind at rest. We
may advise a visit to the dentist and a set of false
teeth, or we may administer a variety of stomach
tonics and sedatives, but if the mind remains filled
with nameless fears and anxieties we shall not
succeed.

In adult life the nervous person when subjected
to excessive stress and strain is seldom free from
dyspeptic symptoms of one sort or another, and what
is true of adult life is even more true of childhood,
when the emotions are more poignant and less
controlled. Then tears flow more readily than in
later life, and tears are not the only secretions
which lie under the influence of strong emotion.
Emotional states, which would stamp a grown man
as a profound neurotic, are almost the rule in in-
fancy and childhood, and may be marked by the
same physical disturbances — flushing, sweating, or
pallor, by the discharge of internal glandular secre-
tions as well as by inhibition of appetite, by vomiting,

54 THE NERVOUS CHILD

gastric discomfort, or diarrhoea. Naturally enough,
mothers and nurses are wont to demand a concrete
cause for the constant crying of a little child, and
teething, constipation, the painful passage of water,
pain in the head, or colic and indigestion are sug-
gested in turn, and powders, purges, or circum-
cision demanded. There can be no doubt that
nervous unrest is capable of producing prolonged
dyspepsia in infancy and childhood — a dyspepsia
which, while it obstinately resists all attempts to
overcome it by manipulation of the diet, is very
readily amenable to treatment directed to quiet
the nervous system.

Where a primary dyspepsia exists for any length
of time, the growth and the nutrition of the child is
clearly altered for the worse. The character of the
stools, their consistency, smell, and colour, is apt to
be changed because the bacterial context of the
bowel has become abnormal. Rickets, mucous
disease, lienteric diarrhoea, infantilism, prolapse of
the rectum, and infection with thread-worms are
common complications. No doubt children with
primary dyspepsia are often nervous and restless,
and the elements of infection and of neurosis are
frequently combined. Yet often we meet with cases
in which the gastric or intestinal disturbance comes
near to being a pure neurosis. The nutrition,
then, seldom suffers to any very great extent, or to
a degree in any way comparable to that which
is characteristic of dyspepsia from other causes.
Emaciation, wrinkling of the skin, dryness and
falling out of the hair, decay of the teeth, are not as

WANT OF APPETITE AND INDIGESTION 55

a rule part of the picture of nervous dyspepsia. The
child may be slim and thin and nervous looking, but
as a rule he is active enough, with a good colour
and fair muscular tone, so that one has difficulty in
believing the mother's statements, which are yet
true enough, as to the trouble which is experienced
in forcing him to eat, or as to the frequency of
vomiting.

In early childhood the difficulty of the refusal
of food often passes or diminishes when the
child learns to feed himself with precision and
certainty. To teach him to do so, it is not
wise to devote all our attention to making him
adept at this particular task. The fault is that
the brain centres which control the movements
of hands, mouth, and tongue have not been
developed, because his activities in all directions
have not been encouraged. It is much less trouble
for a nurse to feed a little child than to teach
him to feed himself, and if he is not given daily
opportunities of practice he will certainly not learn
this particular action. But the fault as a rule lies
deeper. The child who cannot feed himself cannot
be taught until fingers and brain have been devel-
oped in the thousand activities of his daily routine*
by which he acquires general dexterity. A child
who is still too young to feed himself is learning the
dexterity which is necessary as a preliminary in
every action of the day. If he can carry the table-
cloth and the cups and saucers to the tea-table,
imitating in everything the action of his nurse, it
will be strange if he does not also imitate her in the

56 THE NERVOUS CHILD

central scene, the actual eating of the food. If, on
the other hand, he is waited upon hand and foot,
if he is restrained and confined, sitting too much
passively, now in his perambulator, now in his high
chair, now on his nurse's lap, his imitative faculties
and his tactile dexterity alike remain undeveloped.
The child who is slow in learning to feed himself
shows his backward development in every move-
ment of his body. One may note especially the
stiff, " expressionless " hands, indicating a general
neuro-muscular defect. I have seen many children
of eighteen months or two years of age in whom
the movements necessary for efficient mastication
and swallowing had failed to develop satisfactorily.
In some a pure sucking movement persisted, so that
when, for example, a morsel of bread or rusk was
put in the child's mouth, it would be held there for
many minutes and submitted only to suction with
cheeks and tongue. Attempts to swallow in such a
case are so inco-ordinate that they give rise fre-
quently to violent fits of choking, which distress
the child and produce resistance and struggling,
while at the same time they alarm the mother or
nurse so much that further attempts to encourage
the taking of solid food are hastily and for a long
time abandoned. In this helpless condition the
other factors which tend to develop what we have
called negativism have full play. The want of
imitation and the lack of dexterity is not the sole
or perhaps the main cause of the child's refusal of
food and of the apparent want of appetite, but it is
the cause of the failure to learn to feed himself,

WANT OF APPETITE AND INDIGESTION 57

which places him in a condition which is peculiarly
favourable to the operation of other factors. If
only we can teach the child to feed himself, the
difficulties of the situation become much less for-
midable.

The first of the factors which encourage the
persistent refusal of food is the extreme suscepti-
bility of the child to suggestion. A particular
article of diet may be refused on one occasion,
perhaps in pique, because another more favoured
dish was hoped for or expected, or perhaps because
the taste is not yet familiar. Then if on this
occasion a struggle for the mastery is waged, and
a painful impression is made on the child's mind
connecting this particular dish with struggling and
tears, from that day forward the child may per-
sistently refuse it on every occasion it is offered.
Matters are made worse if the nurse, anticipating
refusal, attempts to overcome the resistance by
peremptory orders, or by excessive praise extolling
the delicious flavour with such fervour that the
child's suspicions are at once aroused. Previous
experience has made him connect these excessive
praises with articles which have aroused his dis-
taste. If these fads and fancies on the part of the
child are to be avoided, it is essential that we should
do nothing to focus his attention on his refusal. It
is better that his dinner should be curtailed on one
occasion than that taste and appetite should be per-
verted perhaps for years. Every nurse or mother
should cultivate an off-hand, detached manner of
feeding the child, and should patiently continue

58 THE NERVOUS CHILD

to offer the food without uncalled-for comments
or exhortations. Let her always remember the
force of suggestion on the child's mind, and that a
confident manner which never questions the child's
acceptance will meet with acceptance, while a
hesitating address, from fear of the impending
refusal, will be apt to meet with refusal. Some-
times a still worse fault manifests itself, when nurse
and mother speak before the child of the smallness
of his appetite, and of his persistent refusal of this
or that article of diet. The suggestion then acts
still more powerfully on his mind. He is aware
that the whole household is distressed by his
peculiarity, and he grows to identify it with his
own individuality, and to regard himself with some
satisfaction as possessing this mark of distinction.
If there is any difficulty of this sort it is often
directly curative to reverse the suggestion and to
speak before him of his improving appetite, and to
say that he begins every day to eat better and
better, even if to do so we have to break a good rule
never to say to the child what is not strictly true.
Or once or twice we may take his plate away before
he has finished, saying positively that he has eaten
so much that he must eat no more. If in spite of
every care antipathies to certain articles of food
appear and persist, we must be content to bide our
time. When the child grows of an age to reason,
we should seize every opportunity to make him
feel that his persistent refusal is a little ridiculous
and childish. Little by little the seed is sown, and
will germinate till one day we shall note with surprise

WANT OF APPETITE AND INDIGESTION 59

that he has taken of his own accord that which he
has neglected for so long and with such obstinacy.

But the force which is acting most strongly in
producing this refusal of food is the force of which we
have spoken in a previous chapter — the force which
results in negativism, the force which is in reality
the habit of opposition, the love of power, and the
desire to attract attention. Here again the refusal
of food, if due to this cause, is never the sole mani-
festation of the fault. Just as the delay in learning
to swallow and to chew properly and to feed himself
is part of a general want of dexterity and capacity
manifested in all his actions, so it will seldom happen
that the child's anxiety to oppose is only seen at
meal- times. Watch a nervous child in the nursery
before the dinner hour. He is cross and restless
and inclined to cry. The nurse hands him a doll,
and he throws it away saying, " No, no doll." At
the same moment he may catch sight of his ball, and
it too is violently rejected, " No, no ball." Every-
thing in turn is treated in the same way. Finally
he falls upon his nurse, crying and beating her with
his hands, saying, " No, no Nurse." If that long-
suffering woman at that moment summons him to
dinner, it will be strange indeed if his attitude is not
" No, no dinner," and " No, no " to every mouthful
offered him. How strong this love of opposition
may be is illustrated by the case of a little boy
who was brought to me for refusal of food. Three
weeks before, he had been taken in a motor-car
to his grandfather's to midday dinner on Sunday,
when his absolute refusal of food had spoiled the

60 THE NERVOUS CHILD

day and had occupied the attention and the efforts
of the whole party. Doubtless he had enjoyed
himself, for three weeks later, when he caught sight
of the car which was to bring him to me, and which
he had not seen in the interval, he at once said,
" Not eat my dinner." This child's father told me
that the sight or sound of the preparation of a meal
was enough to bring on a paroxysm of opposition.
Now this force of opposition, as we have seen, only
develops into a serious difficulty when the child's
own will has been opposed too much, when authority
has been too freely exercised, and when the child
has been urged and entreated and reproved with too
great frequency. His opposition grows with all
counter-opposition. And he is not really naughty,
only irritable and restless from the thwarting of
his natural impulses, and unable to express his
thoughts and desires. Negativism will not often
confine itself to meal- times. It will show clearly
in all the actions of the child, and to get him to
eat well and freely we must so change our manage-
ment of him that negativism disappears or at least
diminishes. There is no other way. No entreaty,
no force, no threats of force will ever succeed, but
will only make him worse, and, since negativism
is due to mental unrest, the struggles and crying
will only perpetuate the cause. The one way to
banish negativism and overcome the opposition is
to cease to oppose, and to practise this aloofness
not so much at meal-times, for somehow by patience
the child must be got to take his food, but in all
our conduct to him. Repression and reproof, and

WANT OF APPETITE AND INDIGESTION 61

thwarting of the child's will, and coaxing and en-
treaty must cease. There is no fear that we shall
thereby make the child unduly disobedient. We
have already, in another chapter, decided that
negativism is not strength of will on the part of the
child which must be broken, but is the result of
constant attempts to oppose his nature, and the
consequent nervous unrest. If we cease to oppose,
the symptoms will tend rapidly to disappear, the
child will become busy and contented and happy in
his play, and we shall hear no more of his refusal
of food. If sometimes it recurs for a week or two,
we shall know how to deal with it.

In children, as with us, periods of nervous unrest
and unhappiness are apt to recur in a sort of cy^cle.
This cyclical character of mental disturbance is
often a marked feature. We see it in epilepsy and
and in what the French have called Folie Circulaire.
We see it in the dipsomaniac, in the intermittency
of his craving for drink and of his periodical out-
bursts, and we see it in ourselves in those periods
of depression which recur so often, we know not
why. Little children too sometimes get out on the
wrong side of their beds, and never get right the
whole long day. Their own experience of the
vagaries of mental states should lead mothers to be
indulgent to the children in their days of cloud and
to be particularly careful not to goad them by well-
intentioned efforts into bursts of naughtiness and
passion, each one of which tends to perpetuate the
condition and increase the nervous unrest. We
know how closely dependent is the sensation of

62 THE NERVOUS CHILD

appetite upon emotional states, and we must do all
in our power — and the task is sometimes one of real
difficulty — to keep the child's mind sufficiently at
rest to preserve the healthy desire for food un-
impaired. If there is no sign of appetite, but every
sign of restlessness and irritability, we must seek
in the management of the child until we find the
fault.

If food is taken mechanically and without appetite,
if the preliminary changes in the stomach wall
which are necessary for adequate digestion do not
take place, but are inhibited by the mental unrest,
the meal is apt to be followed by gastric pain and
discomfort, or, more commonly with children, the
stomach may promptly reject its contents. At the
worst, nervous vomiting of this sort may follow
almost every meal, although, again, it is curious
to note how little, comparatively speaking, the
nutrition of the child suffers. The vomiting too, as
in adults, comes very near being a voluntary act,
and mothers and nurses will often remark that they
get the impression that it can be controlled at will.
If once the diagnosis is made that the want of
appetite or the vomiting is of nervous origin, the
treatment of the condition is clear. Sedative drugs
directed towards quieting the nervous excitability
may be of service, but tonics, appetisers, laxatives,
and drugs with a direct action on the stomach will
have but little effect. Nor is there as a rule anything
to be gained by modifying the diet or by excluding
this or that article of food. The frequency of the
vomiting is such that it is apt to have brought

WANT OF APPETITE AND INDIGESTION 63

discredit one after the other upon almost every
article of food which the child can take, with the
result that many useful and necessary foods have
been abandoned for long on the ground that they
are the cause of the dyspepsia. A permanent cure
will only be effected when the faults of environment
have been overcome, when the cause of the nervous
unrest has been removed, and when the child's
mind is at peace.

Nervous vomiting of this kind is not difficult to
control, if those in charge of the children can be
made to under stand that the cause lies in the anxiety
which they themselves show before the child,
increasing his own apprehension or adding to his
sense of power or importance. Once the child is
convinced that his conduct excites no particular
interest, the vomiting soon ceases. In more than
one instance, vomiting which has persisted for many
months has stopped at once after the matter has
been fully explained to the parents. In the most
inveterate case of this sort which has come under
my notice, the child was regularly sick as soon as
he caught sight of a white cloth being laid on the
table for meals. Yet even this child never vomited
when he was under the charge of a particular nurse
who had to return more than once to the family,
and on each occasion was successful in breaking the
habit.

CHAPTER IV

WANT OP SLEEP

SO far, almost all that has been written —
and there has been a great deal of un-
avoidable repetition — has been devoted to an
attempt to determine the causes which lead the
child to refuse food and the methods which we adopt
to prevent or overcome the difficulty. Other neuroses
may be studied in less detail, because they depend
for their existence upon the same causes. For
example, the habit of refusing sleep, which is as
common and almost as distressing as the habit of
refusing food, depends both upon a perversion of
suggestion and upon the phenomenon that we have
called negativism.

If struggling and crying has occurred upon a
series of nights, the child comes to associate his
bed not with sleep but with tears. If a mother
values her peace of mind, if she would spare herself
the discomfort of hearing her child sob himself
nightly into uneasy sleep, she must be wary how this
all-important event of going to bed is approached.
With a nervous and restless child the preliminaries
of preparing for bed must be managed carefully

and tactfully. The hour before bedtime is almost

64

WANT OF SLEEP 65

universally the most interesting of the whole day
for the child. Then the baby, with his best frock
on, and books and toys, is the centre of interest in
the drawing-room, till the clock strikes and the
nurse appears at the door. Suddenly it is all over,
and inexorable routine sends him off to bed. The
good nurse will give the child a little time to recover
from the shock of her arrival, and will not hurry
him. She knows that his little mind is slow to act,
and that he must be led gradually to face a new
prospect. If she hurries him, catching him up in
her arms from the midst of his unfinished pursuits,
resistance and tears are almost sure to follow, and
the difficult task of the day — the putting to bed —
has made the worst possible start. When this has
happened on one or two successive evenings, the
habit of resistance to going to bed becomes fixed,
and, like all bad habits, is difficult to break. A nurse
who has a way with children will arouse his interest
in a new pursuit, in which he can play the chief
part, the putting away of his picture books and
toys. If he is too small to carry his own chair
or table to its allotted place in the room, at least
he can show his learning by pointing out the spot.
In the waving of good-byes he is expert and takes
a legitimate pride, and upstairs he has learnt that
there are new delights. He himself can turn on the
taps in the bathroom, and he can set every article
in the proper place ready for use. All children love
their bath, and if interest and good temper has been
so far preserved, without a break, it will be ill-
fortune if even the drying process is not carried off
5

66 THE NERVOUS CHILD

without a hitch. Afterwards, for a little, nervous
babies, whose brains still teem with all the excite-
ments of the day, are best left to sit for a few
moments by the nursery fire, while the nurse puts
all the garments one by one to bed. Each as it
goes to rest will be greeted by him with cheerful
farewells ; and so does the force of suggestion act,
till the central figure himself plays his part in
the scene, of which he feels himself the controller
and director, and climbs to bed. But if there has
been a hitch anywhere, if the bugbear of negativism
has appeared, if he has been scolded or coaxed or
repressed too much and there have been tears and
struggles, then going to bed is a poor preparation
for instant and quiet sleep.

With excitable, highly-strung children, the best
laid plans and the most tactful nurse will not
always succeed, and to place him in his cot is to
provoke a storm of angry refusal and resistance.
There are mothers who believe that the best way
is then to turn out the light and leave the child to
cry himself to sleep. This is a point on which no
one can lay down rules which are applicable for
all children. It may sometimes succeed, and the
child may reason correctly and in the way we wish
him to reason, deciding that the game is not worth
the candle and so give it up. But with nervous,
highly-strung children I doubt if this Spartan con-
duct is commonly successful. Often if the attempt
is made, the troubled mother, listening to all these
heart-breaking sobs, can bear it no longer, and
goes back to the side of the cot to soothe and per-

WANT OF SLEEP 67

suade him. Then certainly the longer she has
restrained her natural inclination, the longer the
child has sobbed himself into a pitiful little ball of
perspiration and tears, the more difficult will be
her task in quieting him, the stronger will be the
impression formed on the child's mind, and the
greater will be the suggestion which will act under
the same circumstances to-morrow. Children who
fall a prey to this uncontrolled crying, cry on
because they cannot stop when they have begun.
They do not then cry purposely or with a fixed in-
tention, desiring to attain some object. They cry
because their minds are not at rest, but are irritated
and overwrought by the happenings of the day. We
decided that it was useless to attempt by exhorta-
tions at meal-times to induce a nervous child to eat
who habitually refuses food, and that we can only
cure the condition by eliminating from his daily life
the elements of repression and opposition which
provoke the counter-opposition. And we must
seek the same solution in this other difficulty of the
refusal of sleep. It is useless to attempt to treat
the symptom of refusal of sleep and to leave the
cause of that symptom still constantly in action.

If, in spite of our care to avoid unrest and irrita-
tion of the child's brain, sleep is refused, as may
often happen, it is, as a rule, wise to cut short the
crying if we can, before a vicious circle has been
formed and the unrest has been intensified by the
emotional storm. It is useless with little children
to urge them to go to sleep or to coax. It is not
usually wise to leave the child for a little and then

68 THE NERVOUS CHILD

to return. Each time the child is left, each time
the mother or nurse returns, the crying bursts
forth again with renewed force and vigour. It is
at least one good plan with a little child to turn
the light out, and, treating the whole incident in
the most matter-of-fact way possible, lightly to
stroke his head or pat his back rhythmically without
speaking. With older children, if the crying is more
purposeful and less emotional, the mother may
busy herself for a little with some task in the room,
ostentatiously neglecting the storm and making
no reference to it. If she speaks to the child at
all she should do so in a matter-of-fact way, referring
lightly to other matters. If only she can convince
him that his conduct is a matter of indifference to
her, the victory is won. It is because the child
knows so well that his mother does care that he so
often has the upper hand. It is not difficult to
distinguish between a true emotional storm and
the tyrannous cry of a wilful child who demands
his own way.

Light and broken sleep is a common accompani-
ment of a too excitable and overstimulated brain.
The placid child, who eats well, plays quietly, and
does not cry more than is usual, as a rule sleeps so
soundly that no ordinary sounds, such as conversa-
tion carried on in quiet tones in his neighbourhood,
have the power to waken him. When he wakes,
he does so gradually, perhaps yawning and stretch-
ing himself. The nervous child may move at the
slightest sound, or with a sudden start or cry is
wide awake at once. A hard mattress should be

WANT OF SLEEP 69

chosen without a bolster, and with only a low
pillow. Flannel pyjamas, which cannot be thrown
off in the restless movements of the child, should
be worn. The temperature of the room should be
cool, and the air from the open window should
circulate freely, while draughts may be kept from
striking on the child by a screen. All the sensations
of the nervous child are abnormally acute. Thus,
for example, an itching eruption, or tight clothing,
will produce an altogether disproportionate reaction,
and may result in a frenzy of opposition. Especi-
ally such a child is sensitive to a stuffy atmosphere
or to an excess of bedclothes. Cool rooms and
warm but light and porous clothing are essential.
An electric torch, which can be flashed on the child
for an instant, will assist the mother or nurse to
make sure that the child has not thrown off all the
bedclothing.

Sometimes want of sleep is accounted for by a
real want of physical exercise. Town children
especially are apt to suffer from their limited oppor-
tunities of running freely in the open. It is often
considered enough that the child seated in his
perambulator should take the air for three or four
hours daily, while much of his time indoors as well
is devoted to sitting. It is necessary for his proper
development that he should have opportunities of
daily exercise in the open. If for any reason this
is not always practicable, a large room, as free as
possible from furniture, should be chosen, with
windows thrown wide open, in which the child may
romp until he is tired.

70 THE NERVOUS CHILD

It is rare for children of two or of three years of
age, whose case we are now considering, to be
troubled by bad dreams, nightmares, or night-
terrors. If these should occur, obstructed breathing
due to adenoid vegetations is sometimes at work
as a contributory cause.

Finally, we should always remember that refusal
of sleep is, for the most part, caused and kept up by
harmful suggestions derived from mother and nurse,
who allow the child to perceive their distress and
agitation, who speak before the child of his habitual
wakefulness, who unwittingly focus his attention
on the difficulty. It is cured in the moment that
the suggestion in the child's mind is reversed, in
the moment when he comes to regard it as char-
acteristic of himself not to make a fuss about going
to bed, but to sleep with extraordinary readiness
and soundness. Let every one join together to
produce this effect. Let the suggestion act strongly
on his mind that all these troubles of sleeplessness
are diminishing, that night after night sees an im-
provement, and soon his reputation as a good
sleeper will be established, and, as always with
children, it will be rigidly adhered to.

In assisting to break the habit of sleeplessness,
and in the process of altering the character of the
suggestions which act on the child's mind, we can
be of the greatest assistance to the mother by
prescribing a suitable hypnotic. As to whether
it is right in insomnia in childhood to prescribe
depressant drugs is a question on which very
various opinions are held. That it is wrong and

WANT OF SLEEP 71

probably ineffective to trust entirely to the drugs
is certainly true, but as a temporary measure, to
break the faulty suggestion and the bad habit,
their use is both legitimate and successful. The
dose required in children relatively to the adult is
much smaller. In grown people, some specific
distress of mind, whether real or imaginary, may
suffice to resist very large doses of hypnotic. In
children it is rare to find the same resistance, and
comparatively small doses have a very constant
effect. With deeper and more refreshing sleep,
the conduct of the child during the day almost
always changes for the better. A sound sleep, for a
few nights in succession, will produce apparently
quite a remarkable change in the whole disposition
of the child. When good temper and interest take
the place of fretfulness and restlessness, we may
confidently expect that the symptom of sleepless-
ness will begin to abate. Sleeplessness by night
and fretfulness by day form a vicious circle, and
attempts must be made to break it at all points.

Chloral occupies the first place as a hypnotic
for young children. In combination with bromide
its effects are wonderfully constant and certain.
Two grains of chloral hydrate and two grains of
potassium bromide with ten minims of syrup of
orange, given just before bedtime, will bring sound
sleep to a child of a year old. At three years the
dose may be twice as great, and three times at six
years. It is seldom that other means are required.
Aspirin for children seems relatively without effect.
For children who are both sleepless and feverish,

72 THE NERVOUS CHILD

a grain of Dover's powder, and a grain of antipyrin,
for each year of the child's age up to three, is very
helpful. Lastly, if chloral and bromide cannot
break the insomnia, and the condition of the child
is becoming distressing, we can almost always
succeed if we combine the prescription with an
ordinary hot pack for twenty minutes.

CHAPTER V

SOME OTHER SIGNS OF NERVOUSNESS

HABIT SPASM

NEXT to refusal of food and refusal of sleep
perhaps the most frequent manifestation of
nervous unrest is provided by the group of symptoms
which we may call, with a certain latitude of expres-
sion, Habit Spasms. By a habit spasm is meant the
constant repetition of an action which was origin-
ally designed to produce some one definite .result,
but which has become involuntary, habitual, and
separated from its original meaning. The nervous
cough, forms a good example of a habit spasm.
A cough may lose its purpose and persist only as a
bad habit, especially in moments of nervousness, as
in talking to strangers, in entering a room, or at the
moment of saying " How do you do " or " Good-bye."
Twitching the mouth, swallowing, elongating the
upper lip, biting the lips, wrinkling the forehead so
strongly that the whole scalp may be put into move-
ment, and blepharpspasm are all common tricks
of little children which may become habitual and
uncontrolled. In worse cases there may be constant
jerking movements of the head, nodding movements,
or even bowing salaam-like movements. In mild

73

74 THE NERVOUS CHILD

cases we may note hardly more than a restless
movement of mouth or forehead, or constant
plucking or writhing of the fingers whenever the
child's attention is aroused, when he is spoken to,
or when he himself speaks. In nervous children
these movements, which should properly be con-
fined to moments of real emotional stress, become
habitual, and are displayed apart from the ex-
citement of particular emotions. Whatever their
intensity, habitual and involuntary movements of
this nature should not be overlooked, and should
be regarded as evidence of mental unrest. They
do not commonly appear during the first or second
years of the child's life. They are more frequent
after the age of five, but they may begin to be
marked as early as the third year. With refusal of
food and refusal of sleep they form the three common
neuroses of early childhood.

Two of the three qualities which we have men-
tioned as characteristic of the child's mind are
concerned in the causation of habit spasm. In the
early stages the movement is sometimes due to
imitation, but the susceptibility of the child to
suggestion plays the chief part in determining its
persistence. It is an interesting speculation how
far tricks of gesture, attitude, or gait are inherited
and how far they are acquired by imitation. A
child by some characteristic gesture may strikingly
call to mind a parent who died in his infancy. A
whole family may show a peculiarity of gait which
is at once recognisable. It is told of the son of a
famous man, who shared with his father the dis-

OTHER SIGNS OF NERVOUSNESS 75

tinctive family gait, that when a boy his ears were
once boxed by an old gentleman who chanced to
observe him hurrying to overtake his parent, and
who resented what he took to be an act of im-
pertinent caricature. In the reproduction by the
child of the habitual actions of his parents, heredity
is largely concerned, but imitation too plays its part.
In habit spasm the force of imitation is clearly seen.
A child who has developed a habit spasm of one
sort or another will readily serve as a model to
other children. The malady will sometimes spread
through a school almost with the force of a con-
tagious disorder. A child affected in this way
may prove an unwelcome guest. The little visitor
with a trick of contorting his mouth and grimacing
is apt to leave his small host an expert in faithfully
reproducing the action. A cough that is genuine
enough in one member of the family may produce
a crop of counterfeits in brothers and sisters.

The force of suggestion acting upon the child's
mind can clearly be traced. Once his attention is
focused upon the particular movement by unwise
emphasis on the part of the parents, he loses the
power to control its occurrence. This trio of common
neuroses — refusal of food, refusal of sleep, and
habitual involuntary movement — grows only in an
atmosphere of unrest and apprehension. Parents
and nurses anxiously watch their development.
They are distressed beyond measure to note their
steady growth in spite of every attempt which they
make to control or forbid them. And of all this
unrest and unhappiness the child is acutely con-

76 THE NERVOUS CHILD

scious. The whole household may become obsessed
with the misfortune which has befallen it, and the
mother, losing all sense of proportion, feels that
she cannot regain her peace of mind until it has
been overcome. The child is in need of mental and
moral support from those around him, and all that
he finds is an openly expressed apprehension and
sense of impotence. Even grown-up people, when
their nerves are on edge, are apt to be obsessed by
uncontrollable impulses or by vague and nameless
apprehensions, and surely all have learnt the sup-
port they gain from contact and conversation with
some one strong and sane, who treats their worries
in such a matter-of-fact way that immediately they
lose their power and become of no account. The
child with habit spasm cannot control these move-
ments. The more he is reproved or entreated, the
less able does he find himself to hold them in check.
He does not wish them to continue. He has lost
control of what he once controlled, and the realisa-
tion of this is not pleasant, and may be alarming
to him. Yet when unconsciously he looks to his
mother for support, he finds in her open dismay
that which serves only to increase his uneasiness.
She must subdue her own feelings and give the
child strength. If she treats the whole thing in a
matter-of-fact way, as a temporary disturbance
which is of no importance in itself, and only has
meaning because it implies that the brain has been
over-stimulated, she will no longer exercise a pre-
judicial effect on the child. If the bad habit is
taken as a matter of course, if too much is not made

OTHER SIGNS OF NERVOUSNESS 77

of it, if the child is encouraged to think that nobody
cares much about it at all, then recovery will soon
take place. It goes without saying that habit
spasms and tics of all sorts are made worse by
excessive emotional display and by nervous fatigue.
On the other hand, if the child becomes absorbed
in some interesting occupation, the movements
will disappear for the time being.

AIR SWALLOWING, THIGH RUBBING,
THUMB SUCKING

At a somewhat earlier age than that in which
habit spasms become common, and before bed
wetting appears as a formidable difficulty, we meet
with another group of habitual actions which yet
retain their voluntary character. Among such
habitual actions are thumb sucking, thigh rubbing,
and air swallowing. If the child is old enough to
express himself on the subject, he will explain that
these actions are performed because of the satisfac-
tion derived from them, because it is " comfy "
and " nice." Even if the child is too small to speak,
the expression is that of beatitude and content.
These actions are not confined to nervous children,
and their occasional practice need not be taken to
imply that there is any strong element of nervous
overstrain. It is only when the action is repeated
with great frequency and persistence, and when signs
of irritation ensue if gratification is not obtained, that
we are justified in classing it among the symptoms
of mental unrest.

78 THE NERVOUS CHILD

The second of these actions, thigh rubbing, is
found for the most part in little girls, and inasmuch
as it consists of a stimulation of the sexual organs
sometimes causes much distress to the parents. It
is in reality a habit of small importance unless
exercised with very great frequency. It is, of course,
not associated in the child's mind with any sexual
ideas, and is of precisely the same significance as
the other two actions of the same class. Children
who can speak will refer to it openly without any
sense of shame. As a rule the action is performed
in a half -dream state, that condition between
sleeping and waking which is found when the
child is lying in the morning in her cot or in her
perambulator after the midday nap. The child's
attention should not be focused on the symptom.
She should lie on a hard mattress, and when she
wakes in the morning she should either leave her
cot at once or she should be roused into complete
wakefulness by encouraging her to play with her
toys. Little children should be taught to sleep
with their hands folded and placed beside the cheek.
If the movement occurs on going to sleep, it is best
left alone and completely neglected. As a rule
each child has his or her own favourite action of
this class, and they are seldom combined in the same
child. If thigh rubbing is very constant and
obstinate and does not yield to the measures sug-
gested, it may even sometimes be a successful
manoeuvre to substitute the thumb -sucking habit
in the expectation that this less distressing habit
may eject the other more objectionable action.

OTHER SIGNS OF NERVOUSNESS 79

As a rule, however, a wise neglect and careful
watching during the drowsy condition that follows
sleep in a warm bed will succeed in stopping the
practice of thigh rubbing before the end of the
second or third year. Apparatus designed to
restrain movement of the child's legs or blistering
the opposed surfaces of the thighs are both of no
effect. They have indeed the positive disadvantage
that they focus the child's attention on the practice.
The habit ceases only when the child has forgotten
all about it, and these devices serve only to keep
it in remembrance. The same may be said of any
system of punishments. Further, we cannot always
have the child under observation, and at some time
or other opportunity will be found for gratification.
Of older children, in whom self-control and a
sense of honour can be cultivated, I am not here
speaking.

Air swallowing is less common than thigh rubbing,
but belongs to the same group of actions and takes
place in the same drowsy condition. The child will
rapidly gulp down air which distends the stomach,
and is then regurgitated with a loud sound. Thumb
sucking seldom distresses the mother to the same
extent, and the proper attitude of tolerance is adopted
towards it. If much is made of it, it is astonishing
how persistent the habit may become, surviving
all attempts to forbid it, to break it by rewards or
punishments, or to render it distasteful by the appli-
cation of a variety of ill-tasting substances smeared
on the offending digit.

80 THE NERVOUS CHILD

PICA AND DIRT EATING

Certain other bad habits will become ingrained if
attention is called to them, because of that curious
spirit of opposition which characterises little
children, and because of their susceptibility to
suggestion. Some children will constantly pluck
out hairs and eat them, or will devour particles of
fluff drawn from the blankets. Others will seize every
opportunity to eat unpleasant things, such as earth,
sand, mud, or dirt of any sort. All tricks of this
sort are best neglected and treated by attracting
the child's attention to other things. In adult life
they are associated with serious mental disturbance;
in early childhood they are of little account, or at
most suggest a certain nervousness which may be
due to nervous irritation from faults of manage-
ment which we must strive to correct.

CONSTIPATION

As has been already mentioned, much of the
common constipation of the nursery is due
to neurosis. The excessive concentration of the
nurse's thoughts on this daily question communi-
cates itself to the child. The difficulty is emphasised,
and an attempt is made to substitute will power
for forces of suggestion which are at once inhibited
by concentration of the mind upon the process.
Here also, just as in the refusal of food, a further
stage of "negativism," that is, of active resistance
with crying and struggling, is reached, so that com-

OTHER SIGNS OF NERVOUSNESS 81

plaint may be made by the mother that defsecation
is painful. The same negativism may be shown
in micturition, and mothers will give distressing
accounts of the suffering of the child during the
passing of water.

BREATH-HOLDING AND LARYNGISMUS STRIDULTIS

In some children, in the first two years of life,
we find a definite and measurable increase in the
irritability and conductivity of the peripheral
nerves. The strength of current necessary to
produce by direct stimulation of the nerve a minimal
twitch of the corresponding muscle may be many
times less than the normal. Of this heightened
irritability of the nervous system, to which the
name " spasmophilia " has been given in America
and on the Continent, the most striking symptom
is a liability alike to tetany or carpo-pedal spasm,
to generalised convulsions, and to laryngismus
stridulus. In addition, in most cases it is generally
possible to demonstrate the presence of Chvostek's
sign and of Trousseau's sign. Chvostek's sign
consists in a visible twitch of the facial musculature,
especially of the orbicularis palpebrarum or of the
orbicularis oris, in response to a gentle tap adminis-
tered over the facial nerve in front of the ear.
Trousseau's sign is the production of tetany by
applying firm and prolonged pressure to the brachial
nerve in the upper arm. The aetiology of spasmo-
philia is still a matter for dispute, but the evidence
which we possess is in favour of the view that we
6

82 THE NERVOUS CHILI)

have here to deal with a disturbance of calcium
metabolism. The calcium content both of the blood
and of the central nervous system has been shown
to be much lowered. It is in keeping with this that
clinically we note how frequently spasmophilia and
rickets occur in the same child. In some families
the condition recurs through many generations.

For our present purpose — the examination of
some common neuroses of nursery life — it would be
out of place to enter into a detailed consideration
of this disorder of spasmophilia as a whole. The
symptom of laryngismus stridulus — the so-called
breath-holding — alone need concern us, and that
for a special reason. The spasm of the glottis is
produced under the influence of any strong emotion
— in anger, for example, or in fear, in excitement or
in crying for any reason. To control or prevent it
we must direct attention not only to the condition
of spasmophilia, but also to the management of the
children who are always excitable and emotional.
In these children every burst of crying, however
produced, whether by a fall, by a fright, by the
entrance of a stranger, or by a visit to a doctor, is
apt to be ushered in by a long period of apncea,
due to spasm of the glottis and of the diaphragm.
The first few expirations are not followed by any
inspiration. For several seconds the silence may be
complete, while the child steadily becomes more and
more cyanosed, or the body may be shaken by
incomplete expiratory movements and strangled
cries which are suppressed because the chest is
already in a position of almost complete expiration.

OTHER SIGNS OF NERVOUSNESS &s

In the worst cases, when the apncea lasts a very long
time, there may be convulsive twitching of the
muscles of the face, or the attack may even ter-
minate in general convulsions. Very occasionally
the spasm is actually fatal. In all fatal cases
which have come to my notice the child at the
moment of death had been alone in the room. I
have met with no fatal case where the baby could
be picked up and assisted. As a rule, therefore,
the cause and mode of death must be conjectural,
but when an infant is found dead in its cot unex-
pectedly, it would seem likely that it has waked
from sleep with a sudden start, become excited,
and, about to cry, has been seized by the fatal
spasm. In two instances reported to me a cat had
been found in the room with the dead child, and it
was suggested that the animal had lain upon the
child's face. Both these children, however, were
vigorous and capable of powerful movements of
resistance. I think it more likely that the cat may
have awakened them in fright, and that the emotional
excitement, giving rise to the spasm, was the cause
of the suffocation. That the apncea in these
extremely rare instances should end fatally pro-
duces a difficult position for the doctor. It need
hardly be said that the seizures are alarming to
the parents. For the sake of great accuracy in
the statement of our prognosis are we to add a
hundred times to the mother's alarm by stating the
possibility of death ? In each case we must use
our own judgment. I believe that in a child over
a year old the risk is almost negligible.

84 THE NERVOUS CHILD

Fortunately in all save the rarest possible in-
stances the apnoea yields and a deep inspiratory
movement follows. As the air rushes past the
glottis, which is still partially closed, a sound recalling
the whoop of pertussis is heard. Often this recurs
throughout all the burst of crying which follows,
and each inspiration is accompanied by a shrill
stridulous sound. With the re-establishment of
respiration the cyanosis rapidly fades, to be suc-
ceeded in some cases by pallor and perspiration.

It need hardly be said that we should do all in
our power to prevent these alarming and distressing
attacks. Each seizure predisposes to a repetition.
In some children we notice that months and even
years after an attack of whooping-cough, a slight
bronchial catarrh may be sufficient to bring back
the characteristic cough. In laryngismus in the
same way we may suppose that the reflex path is
made easy and the resistance lowered by constant
use. Fortunately the spasms are not usually
difficult to control. Calcium bromide, in doses of
from two to four grains, according to age, three times
daily, is generally successful with or without the
addition of chloral hydrate in small doses. At the
same time we must endeavour in every way possible
to keep the child calm, by paying close attention to
nursery management. The child with spasmophilia
is as a rule excitable and easily upset, and although
calcium bromide is a drug which offers powerful
aid it is not able to achieve its effect unless we are
able at the same time to guarantee a reasonable
immunity from emotional upsets. It is for this

OTHER SIGNS OF NERVOUSNESS 85

reason that I have included some description of
laryngismus, although its origin is undoubtedly
very different from that of the other disorders of
conduct which we have examined.

MIGRAINE AND CYCLIC VOMITING

The aetiology of cyclic or periodic vomiting in
childhood is not yet completely understood. We
do not know how far it is dependent upon disturb-
ance of the liver, and it is still disputed whether the
acidosis which accompanies it is the cause or the
result of the profuse vomiting. Into these difficult
questions we need not at the moment enter. It is
enough in the present connection to recognise that
the great majority of children who suffer from
cyclic vomiting are sensitive, excitable, and nervous,
and that every one is agreed that the nervous system
is intimately concerned in its causation.

A close association between cyclic vomiting in
children and that form of periodic headache known
as migraine has often been observed. It is some-
times found that one or both parents of a child
with cyclic vomiting suffer habitually from migraine.
In a few instances the one condition has been
observed to be gradually replaced by the other, the
child with cyclic vomiting becoming in adult life a
sufferer from migraine. There is indeed much
which is common" to the two conditions. The
periodic nature of the seizure, often following a time
when the general health and vigour appear to have
been at their optimum, the extreme prostration,

86 THE NERVOUS CHILD

and the comparatively sudden recovery are found
in both. In the cyclic vomiting of children, it is
true, little complaint is made of headache, the visual
aura is absent, and the vomiting is invariably the
most prominent symptom.

Cyclic vomiting seldom occurs before the fourth
year. It is characterised by sudden profuse and
persistent vomiting and by very great prostration.
All food, it may be even water, is promptly rejected.
The vomited matter is generally stained with bile ;
occasionally the violence of the vomiting causes
hsematemesis. In many cases the temperature is
raised ; sometimes it may be as high as 103° F.
The duration of an attack varies. In most cases
it does not last longer than forty-eight hours. On
the other hand, attacks lasting as long as a week
are by no means unknown. Within a short time
of the onset the urine may be found to contain
acetone bodies, the breath may smell distinctly of
acetone, and the child may become torpid and drowsy
or agitated and restless. At times there may be
exaggerated and deepened respiratory movements —
the so-called air hunger. In many cases, however,
otherwise characteristic, these more severe mani-
festations are absent or but little apparent. Re-
co very is usually rapid and complete. The child asks
for food, which is retained. A fatal ending is very
rare, though not unknown. The frequency of attacks
is very various. Sometimes months or even years
may elapse between successive seizures; in other
cases a fortnightly or monthly rhythm establishes
itself.

OTHER SIGNS OF NERVOUSNESS 87

It is clear that both the frequency and the severity
of the attacks are much influenced by the general
state of the child's health. Like migraine, cyclic
vomiting appears to be a symptom of nervous
exhaustion. It affects, for the most part, children
who are intellectually alert, impressionable, and
forward for their age, and who, when well, throw
themselves into work or play with a great expendi-
ture of nervous energy. Often their physical
development is unsatisfactory, and we must set
ourselves to correct this as the first step in pre-
vention. It is highly important that children
suffering in this way should have free opportunities
for exercise in the open country, and that all the
excretory organs — the skin, kidneys, and bowels —
should be acting freely and efficiently. The child
should live a life of ordered routine. Sleep should
be sound and sufficient in amount. The diet must
not exceed the strict physiological needs. Many /
of these children appear to have a lowered tolerance
for fats of all sorts, and it may be necessary to
limit strictly the consumption of milk, cream, butter,
and so forth. A daily administration of a small
dose of alkali by the mouth is credited with pre-
venting attacks. In the present connection, how-
ever, we shall not do wrong to emphasise the part
played by the nervous system in the production of
the attacks. In all cases of cyclic vomiting it
should be our endeavour to recognise and remove
the elements in the daily life of the child which are
proving too exhausting.

88 THE NERVOUS CHILD

UNEXPLAINED PYEEXIA

In nervous children we sometimes meet with
inexplicable rises of temperature. The pyrexia
may have the same periodic character as that just
noted in cases of cyclic vomiting. At intervals
of three, four, or five weeks there may be a rise
of temperature to 103° F., or even higher, which
may last for two or three days before subsiding.
In other cases the chart shows a slight persistent
rise over many weeks or months. That in nervous
children the temperature may be very considerably
elevated without our being able to detect much
that is amiss does not of course make it any the
less necessary to be careful to exclude organic dis-
ease. Pyelitis, tuberculosis, and latent otitis media
occur with nervous children as with others and must
not be overlooked. If, however, organic disease
can be excluded, and if the pyrexia is the only
circumstance which prevents the decision that the
child is well and should be treated as well, then the
thermometer may be overruled and the pyrexia
neglected.

CHAPTER VI
ENURESIS

I HAVE dealt in previous chapters with certain
common disorders of conduct in childhood,
which show clearly their origin in the apprehensions
of the grown-up people who have charge of the
children, and in the unwise suggestions which they
convey to them. The same forces are at work in
the production of enuresis, or bed wetting, although
the matter is here often complicated by the develop-
ment later on of a sense of shame and unhappiness
in the child. There comes a time when the child
passionately desires to regain control and is miser-
able about her failure, until the concentration of her
thoughts on the subject becomes a veritable obses-
sion. Every night she goes to bed with this only
in her mind. Every night she falls asleep, miser-
ably aware that she will wake to find the bed
wetted. The suggestion impressed in the first
place on the mind of the tiny child by injudicious
management has become fixed by the growing sense
of shame and the complete loss of self-confidence.

It is usually taught that a great variety of causes
is concerned in producing enuresis. It is said to

be due to a partial asphyxia during sleep from

89

90 THE NERVOUS CHILD

adenoid vegetation. It is said to be caused by
phimosis, and to be cured by circumcision. It is
said that the urine is often too acid and so irritating
that the bladder refuses to retain it for the usual
length of time. It is said that enuresis may be due
to a deficiency of the thyroid secretion, and that it
can be cured by thyroid extract. Such a number
of rival causes may make us hesitate to accept the
claims of any one of them. Certainly I have not
been able to satisfy myself that any one of these
conditions exercises any influence at all or is
commonly present in cases of enuresis. I think
that if we examine a large number of cases of bed
wetting in children we can come to no other con-
clusion than that the cause of the trouble is due to
just such a pervasion of suggestion as we have been
considering above.

There are certain points in the behaviour of a
child with enuresis which seem to point to this
conclusion.

(a) In the first place, the trouble is seldom serious
or very well developed in early childhood, and the
reason for this, I take it, is that an occasional
lapse in a child of perhaps two or three years of
age is usually treated lightly and in the proper
spirit of tolerance. It is only with children a little
older that nurses and parents become distressed
and begin unwittingly by urging the child to pre-
sent the suggestion to her mind, that the bed may
or will be wetted. Hence the usual history is that
control was partially acquired in the second year,
but that, instead of later becoming complete, re-

ENURESIS 91

lapses began to be more frequent, and that since
that time all that can be done seems only to make
matters worse.

(6) In the second place, the influence of sugges-
tion is shown by the behaviour of the child when
removed to a hospital for observation. It is the in-
variable experience that the enuresis then promptly
stops. In hospital the attitude of those around
the child is entirely different. She has the com-
fortable and consoling feeling that in wetting the
bed she is doing exactly what is expected of her.
There is even a feeling that otherwise she is showing
herself to be something of a fraud, and that she has
then been admitted to the hospital on false pretences.
Hence, perhaps for the first time in many years,
the child is free from the obsession, and the bed is
not wetted.

(c) In the third place, it is easy to recognise in
the history of many of the cases, the ill-effects of
circumstances which add new force to the fear of
failure or shake the confidence in the control which
had been regained. Thus a boy, an only child,
who had suffered from enuresis till his seventh year,
had regained complete control till his eleventh
year, when he went to school. In his dormitory at
school was a boy who had enuresis, and who was
being fined and punished by the schoolmaster.
The enuresis at once reappeared and continued
unchecked so long as he was at school. As might
be expected, school life is very inimical to cure,
unless the trouble can be kept from the knowledge
of the other boys. Anything which directly in-

92 THE NERVOUS CHILD

creases the nervousness of the child — an illness, for
example, with loss of weight and failure of nutri-
tion, or some mental stress, such as the approach
of an examination — is apt to accentuate the enuresis.

(d) In the fourth place, the incontinence some-
times spreads to the daytime, and the child is wet
both by day and night! Further, in bad cases it
is not uncommon to find incontinence of faeces
making its appearance also. These extensions ol
the fault only take place when the management
continues to be very faulty, when the grown-up
people around them are more than usually distressed
and pessimistic, and have redoubled their expostula-
tions and appeals.

Now these peculiarities of enuresis seem to me
only explicable if we assume that the want of
control is due to auto-suggestion, dependent at the
beginning on the unwise attitude adopted towards
the fault by the nurses and parents, and later
kept up by the sense of shame and the mental
distress involved.

The forms of treatment which have been re-
commended from time to time are, as might be
expected, very numerous.

(a) Operative. — (i) Removal of tonsils and ade-
noids, (ii) Circumcision.

(b) Manipulative. — (i) Injection of saline solu-
tion under the skin in the perineal and pubic
regions, with object of lowering the excitability of
the bladder by counter-irritation, (ii) Gradual
distension of the bladder by hydrostatic pressure,
(iii) Tilting the foot of the bed so as to throw the

ENURESIS 93

urine to the fundus of the bladder, in order to
protect the sensitive trigone from irritation.

(c) Educative. — (i) Curtailing the fluid drunk,
(ii) Waking the child at intervals during the night
by an alarm clock or otherwise, (iii) Rewards and
punishments.

(d) Medicinal. — (i) Belladonna, (ii) Thyroid ex-
tract.

(e) By Suggestion. — (i) By simple suggestion,
(ii) By hypnotic suggestion.

I do not think that any single one of these various
forms of treatment outlined under the first four
heads has any effect other than to aid the suggestion
of cure which we proffer in adopting it. Removal
of tonsils and adenoid vegetations might conceivably
cure an enuresis which is nocturnal, it cannot account
for an incontinence which spreads to the day. We
might believe that to distend the bladder by hydro-
static pressure was a cure for incontinence of urine,
and that it acted by removing the local cause,
— the smallness and contraction of the bladder, —
were it not that the loss of control is so apt to
spread to the rectum as well. There is no evidence
that the urine is peculiarly irritating. Indeed,
such evidence as we have goes to show that, as in
some other neuroses, the urine in enuresis is unduly
copious, and of very low specific gravity. Inci-
dentally, we have in this polyuria a further argu-
ment against the view recently advanced that a
small and contracted irritable bladder is the cause
of enuresis. We do, of course, meet with cases of
irritable bladder often enough, but the complaint is

$4 THE NERVOUS CHILD

then not of incontinence, but always of the discomfort
of having to rise so frequently for micturition.

To deprive the child of fluid, to wake her many
times at night, to tilt the foot of the bed, are devices
which may help in the hands of some one who is
confident of his ability to cure the condition and
can communicate the confidence to the child.
Carried out hopelessly and pessimistically by a
tired and exasperated mother, they are well calcu-
lated to strengthen the hold which the obsession has
on the child, so that often we meet with a mother
who rightly enough maintains that the more she
wakes the child, the oftener the bed is wet, till she
wonders where it all comes from.

The treatment of enuresis to be successful must
be conducted through and by means of the grown-
up persons who have the control of the children. To
stop the development of enuresis in early infancy
we must intervene to prevent the concentration of
the child's mind on the difficulty. During the
time when control is ordinarily developed, in the
second and third year, judicious management of the
child is essential. The emphasis should be laid upon
successes, not upon failures. For every child his
reputation will sway in the balance for a time.
He must be helped and encouraged to self-con-
fidence, not rendered diffident or self-conscious.

If the case is well established before it comes
under our notice, the mother, the nurse, the school-
master, or whoever is responsible for the child's
management, must understand clearly the nature
of the trouble. The suggestion acting on the

ENURESIS 95

child's mind must be altered, and self-confidence
restored. The child must learn to see that the
thing is not so desperately tragic. He should be
told that the trouble always gets well, and that it
only goes on now because he is worried about it
and keeps thinking of it. If the whole environ-
ment of the child is bad, so that such a change of
suggestion is not possible, and if enuresis is but one
of many symptoms of mental or moral instability,
it may be necessary to remove the child and place
him under the influence of some one else. Sometimes
the prescription of a rubber urinal, which the child
can slip on at night, is directly curative. A public
school boy, who was about to be sent away from
school for this failing, fortified by the possession
of this apparatus, wrote six months later to say
that he knew now that it must be all worry that
caused the trouble, because with the urinal in
position he had not once had the incontinence.

In inveterate cases hypnotic suggestion is always,
I think, successful. It is obvious, however, that
in many cases there are objections to its use. Often
enuresis is evidence that the child's home environ-
ment has been at fault, and that his mental and
moral development has been retarded. It is the
management which must be modified or the home,
if necessary, changed. Hypnotic suggestion will
make this one symptom disappear promptly enough,
but it will rather perpetuate than combat the cause
— that undue susceptibility to suggestion, which is
characteristic alike of the little child and of many
older neuropathic persons.

CHAPTER VII
TOYS, BOOKS, AND AMUSEMENTS

ANY one who has an opportunity of watching
little children must have observed that
they are happiest and most contented when playing
alone. The education of the little child is carried
on by means of games and toys. Handling the
various objects which we give him, imparting
movement to them, transferring them from hand
to hand and from one situation to another, he learns
dexterity and precision of movement, and in the
process hand and brain grow in power. When at
play, his whole energies should be absorbed to the
exclusion of everything else. He will often be
oblivious to everything that is going on around him,
intent only on the purpose of the moment. In
order to permit this fervour of self-education it is
necessary that the child should be accustomed to
playing alone, and it is well, if only for convenience'
sake, that he should be accustomed to playing in a
room by himself. Something is wrong if the child
cannot be left for a few moments without breaking
into tears or displaying bad . temper. Engrossed
in his own tasks, he should be content to leave his
nurse to move in and out of the room without

TOYS, BOOKS, AND AMUSEMENTS 97

protest. If this fault has appeared and the child
cannot be left alone, our whole educational system
is undermined, and play will be profitless and over-
exciting, because it demands the constant partici-
pation of grown-up people. As a preliminary to all
improvement in the management of a nervous child,
we must see to it that he becomes accustomed to
being alone. We must so arrange his nursery
that he can do no damage to himself. Scissors and
matches must not be left lying about, and a fire-
guard must be fixed in position so that it cannot be
disturbed. Then, disregarding his protests, the
nurse must leave him to himself, at first only for a
moment or two, re-entering the room in a matter-of-
fact way without speaking to him, and again leaving
it. Soon he will learn that a temporary separation
does not mean that we have abandoned him for all
time. Then the period of absence can be gradually
lengthened till all difficulty disappears. Once his
attention is removed from the grown-up people who
mean so much to him, his natural impulse to explore
and experiment with his playthings will show itself.
Those toys are best which are neither elaborate nor
expensive. For a little child a small box contain-
ing a miscellaneous collection of wooden or metal
objects, none of them small enough to be in danger
of being swallowed, forms the material for which
his soul craves. Everything else in the room may
be out of his reach. A dozen times he will empty
the box and then replace each object in turn. He
will arrange them in every possible combination,
and then sweep the whole away to start afresh.
7

98 THE NERVOUS CHILD

At eighteen months of age observation and imitative
capacity will have made more complex pursuits
possible. As a rule the objects which are most
prized and which have most educative value are
those which lend themselves best to the actions
with which alone the child is familiar. Hence
the supreme importance of the doll and the doll's
perambulator. The doll will be treated exactly
as the child is treated by the nurse. It will be
washed, and dressed, and weighed, and put to bed
in faithful reproduction of what the child has daily
experienced. Dusting, and sweeping, and laying
the table will be exactly copied. If a child has no
opportunity of being familiar with horses, if he has
not seen them fed, and watered, and groomed, and
harnessed, he may not find any great satisfaction
in a toy horse, or pay much attention to it, no
matter how costly or realistic it may be.

In the third year more precise tasks, such as
stringing beads, drawing, and painting, will play
their part, while at the same time the increased
imaginative powers will give attraction to toy
soldiers or a toy tea-service. Playing at shop,
robbers, and rafts are developments of still later
growth. In the child's games we recognise the
instinct of imitation — playing with dolls, sweeping
and dusting, playing at shop or visitors ; the instinct
of constructiveness — making mud pies and sand
castles, drawing or whittling a stick ; and the
instinct of experiment — letting objects fall, rattling,
hammering, taking to pieces. All this activity must
be encouraged, never unduly repressed or destroyed.

TOYS, BOOKS, AND AMUSEMENTS 99

But whatever form it takes, the bulk of the play
must be carried on without the intervention of
grown-up persons, or it will lose its educative value
and prove too exacting. If grown-up people
attempt to take part, the child will lose interest in
the play and turn his attention to them.

Children differ very much in their attitude towards
books. One child quite early in the second year
will be happy poring over picture books, while
another will seldom glance at the contents and
finds pleasure only in turning over the pages,
opening and shutting them, and carrying them
from place to place. Such differences are natural
enough and foreshadow perhaps the permanent
characteristics that divide men and women, and
produce in later life men of thought and men of
action, women who are Marthas and women who
are Marys. Nevertheless, we should bear in mind
that there is danger in a training that is too one-
sided, and that books and toys have both their
part to play in developing the powers of the child.
All the activities of the child should be used in
as varied a way as possible. The eye is but one
doorway to knowledge and understanding, the ear
is another, the hand a third.

From pictures an imaginative child will derive
very strong impressions, and mothers should be
careful in their choice. It is foolish to confuse
the growth of aesthetic perceptions by present-
ing children with books which depict children as
grotesquely ugly beings with goggle eyes and heads
like rubber balls. Children love animals and

100 THE NERVOUS CHILD

endow them with all their own reasoning attributes,
and in stories of the home life of rabbits, and bears,
and squirrels they take a pure delight. Books of the
" Straw welpeter " type are less to be recommended.
The faults which they are intended to eradicate
become peculiarly attractive from much familiarity.
A little boy of two and a half who resolutely refused
all food for some days was in the end detected to
be playing the part of that Augustus, once so chubby
and fat, who reduced himself to a skeleton, saying,
" Take the nasty soup away ; I don't want any
soup to-day." Tales of naughty children who meet
with a distressing fate may either frighten the child
unduly, or else produce in a child of inquiring mind
the desire to brave his fate and put the matter to the
test. Pictures should not be terrifying or horrible.
Ogres devouring children are out of place as sub-
jects for pictures and may cause night-terrors.

Children should be taught to be careful of books
and toys. The indestructible book, generally falsely
so called, is often responsible for the immediate
dissolution of all others less protected which come
to hand. The sympathy which little children
have with the sufferings of all inanimate objects
and their habit of endowing them with their own
sensations may be made of use in teaching them
care and gentleness. They are naturally prone to
sympathise with the doll that has been crushed or
the book that has been torn. They will learn very
easily to be kind to a pet animal and to be solicitous
for its feelings, and the lesson so learnt will be
applied to inanimate objects as well.

TOYS, BOOKS, AND AMUSEMENTS 101

There is, however, another side to the question.
It is true that if the child is not to be over-stimulated
upon the psychical side, we must see to it that his
play, for the most part, is not dependent upon
the participation of grown-up persons. In practice
this excessive stimulation is the common fault with
which we meet. There are few children in well-to-do
homes, with loving mothers and devoted nurses,
who suffer from too little mothering and nursing.
Too many show signs of too much. To observe
the opposite fault we must seek the infants and
children who for a long time are inmates of institu-
tions, orphanages, infirmaries, hospitals, and so
forth. In such surroundings the mental life of the
child may languish. His physical wants are cared
for, but there the matter ends. In a rigid routine
he is washed and fed, but he may not be talked to
or played with or stimulated in any way. His day
is spent passively lying in his cot, unnoticed and
unnoticing. I have seen a poor child of three
years just released from such a life, and after
eighteen months returned to his mother, unable to
talk and almost unable to walk, crying pitifully
at the novelty and strangeness of the noisy life to
which he had returned, worried by contact with
the other children, and without any desire or power
to occupy himself in the home. For an hour in
the day mothers may devote themselves whole-
heartedly to the children, and if they set them
romping till they are tired out, so much the better.
In the garden or in an airy room with the windows
open, a game with a ball or a toy balloon, or a

102 THE NERVOUS CHILD

game of hide-and-seek, will be all to the good, and
the children may climb and be rolled over and swung
about to their heart's content. With an only
child, especially with a child whose home is in town,
and whose outings are limited to a sedate airing
in the park, such free play is especially necessary.
It may help more than anything else to quiet
restless minds and tempers that are on edge all
day long from excessive repression.

On the other hand, those forms of entertainment
which are known as " children's parties " are gener-
ally fruitful of ill results, at any rate with nervous
and highly-strung children. Sometimes they entail
a postponement of the usual bedtime, and nearly
always they involve over-heated and crowded
rooms. Perverse custom has decreed that these
gatherings shall take place most commonly in the
winter, when dark and cold add nothing to the
pleasure and a great deal to the risk of infection
which must always attend the crowding of sus-
ceptible children together in a confined space with
faulty ventilation. There is clearly on the score
of health much less objection to summer garden
parties for children, but these for some reason are
less the vogue. As a rule parties are not enjoyed by
nervous children. There is intense excitement in
anticipation, and when at length the moment
arrives, there is apt to be disillusion. Either the
excitement of the child may pass all bounds and end
in tears and so-called naughtiness, or the unfamiliar
surroundings may leave him distrait with a strange
sense of unreality and unhappiness. It is not

TOYS, BOOKS, AND AMUSEMENTS 103

always fair to blame the want of wisdom in his
hostess's choice of eatables, if the excited and over-
stimulated child fails in the work of digestion and
returns to the nursery to suffer the reaction, with
pains and much sickness.

The same arguments may be urged against taking
little children to the theatre. The nerve strain
is apt to be out of proportion to the enjoyment
gained. If children must go to theatres and parties,
the treat should be kept secret from them until
the moment of its realisation, in order that the
period of mental excitement should be contracted
as much as possible, and grown-up people should be
advised to treat the whole expedition in a matter-of-
fact sort of way that does nothing to add to the
excitement or increase the risk of subsequent dis-
illusion.

CHAPTER VIII

NERVOUSNESS IN EARLY INFANCY

WE may now pass back to consider the nervous
system of the child in infancy. There, too,
from the moment of birth there are clearly-marked
differences between individuals. The newborn baby
has a personality of his own, and mothers will note
with astonishment and delight how strongly marked
variations in conduct and behaviour may be from
the first. One baby is pleased and contented,
another is fidgety, restless, and enterprising. At
birth the baby wakes from his long sleep to find
his environment completely changed. Within the
uterus he lies in unconsciousness because no ordinary
stimulus from the outer world can reach him to
exert its effect. He lies immersed in fluid, which,
obeying the laws of physics, exercises a pressure
which is uniformly distributed over all points of his
body. No sound reaches him, and no light. After
birth all this is suddenly changed. The sense of
new points of pressure breaks in upon his conscious-
ness. Cold air strikes upon his skin. Loud sounds
and bright lights evoke a characteristic response. A
placid child who inherits a relatively obtuse nervous

organisation will be but little upset by this sudden

104

NERVOUSNESS IN EARLY INFANCY 105

and radical change in the nature of his environment.
His brain is readily but healthily tired by the new
sensations which stream in from all sides, and he
falls straight away into a sleep from which he rouses
himself at intervals only under the impulse of the
new sensation of hunger.

Babies of nervous inheritance, on the other hand,
will show clearly by the violence of the response
provoked that their nervous system is easily stimu-
lated and exhausted. They will wriggle and
squirm for hours together, emitting the same
constant reflex cry. The whole' body will start
convulsively at a sudden touch or a loud sound
which would evoke no response from a more stolid
infant. The sleeplessness and crying exhaust the
baby, rendering the nervous system more and more
irritable, while the sensation of hunger which is
delayed in other children by twelve hours or more
of deep sleep appears early and is of extreme
intensity. We must see to it that sense stimuli
are reduced to the lowest possible level. True, we
cannot again restore the child to a bath of warm
fluid, of the same temperature as his body, where
he can be free from irksome pressure and from all
sensations of sound and light, but we can so arrange
matters that he is not disturbed by loud sounds
and bright lights, and that he is not moved more
than is necessary. Sudden unexpected movements
are especially harmful. Jogging him up and down,
patting him on the back, expostulation, and en-
treaties are all out of place and do all the harm in
the world. The first bath should be as expeditious

106 THE NERVOUS CHILD

as possible, and above all the baby must not be
chilled by tedious exposure. Cold irritates his
nervous system more than anything else, unless it
be excessive warmth. In preserving the proper
temperature so that we do not render the child
restless by excess of heat or by excess of cold, we
too-civilised people have made our own difficulties.
We have exaggerated the completeness of the
sudden separation of mother and child which nature
decrees. It is the function of all mother animals
to approximate the unstable temperature of the
newly born to their own by the close contact of
their bodies, which provide just the proper heat.
Labour is nowadays so complicated and exhausting
a process for mothers that, all things considered,
we are wise in completing the separation of mother
and child and in removing the baby to his own cot.
But the difficulty remains, and we must arrange that
any artificial heating needed is constant and of
proper degree.

If the baby is very restless and irritable, too wide
awake and too conscious of his surroundings, the all-
important task of getting him to the breast and
getting him to draw the milk into the breast is apt to
be difficult. His sucking is a purely reflex and invol-
untary act. It can be produced by anything which
gently presses down the tongue, and a finger placed hi
the proper position will provoke the movement with-
out the child's consciousness being aroused. The
placid child whose mind is at rest will suck well and
strongly. If, on the other hand, the brain is too
much stimulated and the child is restless and

NERVOUSNESS IN EARLY INFANCY 10?

irritable, the reflex act of suction is inhibited, and
it is a difficult matter to get the child to the breast.
He is too eager, mouthing, and gulping, and
spluttering. Or sometimes his mental sufferings
seem too much for his appetite, and though wide
awake and crying loudly, he refuses to grasp the
nipple, turning his head away and wriggling blindly
hither and thither. This effect of mental unrest
on the newborn infant is often disastrous, because
it is one of the common causes of the failure of
women to nurse their children. This is not the
place to sketch in detail a scheme for the proper
technique of breast nursing, a matter which is much
misunderstood at the present day. It will be
enough shortly to say that an efficient supply of
milk depends upon the complete and regular empty-
ing of the breast. The breasts of all mothers will
secrete milk if strong and vigorous suction is applied
to the nipple by the child. If anything interferes
with suction, the milk does not appear or, if it
has appeared, it rapidly declines in amount. The
mother's part is to a great extent a passive one,
provided that she can supply one essential — a nipple
that is large enough for the child to grasp properly.
Within wide limits what the mother eats or drinks,
whether she be robust or whether she has always
been something of an invalid, matters not at all. A
frail woman may naturally not be able to stand the
strain of nursing for many months, but that is not
here the point in question. We are dealing only
with the establishment of lactation and with the
milk supply of the early days and weeks which is

108 THE NERVOUS CHILD

of such vital importance for the child. If the
mother is ill, if, for example, she has consumption,
we may separate her from the child in the interests
of both ; but if this is not done, she will continue to
secrete milk for a time as readily as if she were in
perfect health, and the breasts of many a dying
woman are to be seen full of milk. Mothers are too
apt to attribute the disappointment of a complete
failure to nurse to some weakness or want of robust-
ness in their own health. This is never the reason
of the failure, and the fault, if the mother has a well-
formed nipple, is generally to be found in some
disturbance in the child. Prematurity, with ex-
treme somnolence, breathlessness from respiratory
disease, nasal catarrh, which hinders breathing
through the nose, infections of all sorts, are common
causes of this failure to suck effectively. But
perhaps the most common cause of all is the in-
hibition from nervous unrest of that reflex act of
sucking which works so well in the placid and
quiet child. It is a point to which too little atten-
tion is paid, and mothers and the books which
mothers read commonly neglect the nervous system
of the child and devote themselves to such con-
siderations as the relative merits of two-hourly
and four-hourly feedings — important points in their
way, but less important than this.

The matter is complicated in two other ways.
In the first place, the nervous baby, just because he
is so active and wakeful and restless, is apt rapidly
to lose weight and to have an increased need for
food. The restlessness is generally attributed to

NERVOUSNESS IN EARLY INFANCY 109

hunger, and this is true, because hunger is soon
added to the other sensations from which he suffers,
and like them is unduly acute. It is difficult not
to give way and to provide artificial food from
the bottle. Yet if we do so we must face the
fact that these restless little mortals are quicker
to form habits than most, and once they have
tasted a bottle that flows easily without hard
suction, they will often obstinately refuse the
ungrateful task of sucking at a breast which has
not yet begun to secrete readily. The suction
that is devoted to the bottle is removed from the
breast, and the natural delay in the coming in of
the milk is increased indefinitely. At the worst,
the supply of milk fails almost at its first appear-
ance. We must devote our attention to quieting the
nervous unrest by removing all unnecessary sensory
stimulation from the baby. He must be in a warm
cot, in a warm, well-aired, darkened, and silent
room, and the necessary handling must be reduced
to a minimum. Sometimes sound sleep will come for
the first time if he is placed gently in his mother's
bed, close to her warm body. If he is apt to bungle
at the breast from eagerness and restlessness, it is
not wise always to choose the moment when he has
roused himself into a passion of crying to attempt
the difficult task. So far as is possible he should
be carried to the breast when he is drowsy and
sleepy, not when he is crying furiously, and then
the reflex sucking act may proceed undisturbed.

In the second place, we must guard against the
ill effect which the ceaseless crying of these nervous

110 THE NERVOUS CHILD

babies has upon the mother. She may be so ex-
hausted by the labour that her nerves are all on
edge, and she grows apprehensive and frightened
over alt manner of little things. The tired mother
is apt to fear that she will have no milk, and her
agitation grows with each failure on the part of
the child. Now the first secretion of milk is very
closely dependent upon the nervous system of the
mother. We have said that within wide limits
her physical condition is of less importance, but
her peace of mind is essential. And so it is wise for
some part of the day to keep the nervous baby out
of hearing of the mother, and so far as possible
to choose moments when the child is quiet to put
him to the breast. A nurse with a confident,
hopeful manner will effect most ; a fussy, over-
anxious, or despondent attitude will do untold
harm. We shall sometimes fail if the nervous
unrest is very obstinate either in mother or in child,
but we shall fail less often if we diagnose the cause
correctly in the cases we are considering. Lastly,
it is possible to control the condition in both mother
and child by the careful use of bromide or chloral.
It is not, of course, suggested that these drugs
should be given freely or as a routine to every
hungry baby wailing for the breast, or that we can
hope to combat or ward off an inherited neuro-
pathy by a few doses of a sedative. There are,
however, not a few babies in whom there develops
soon after birth a sort of vicious circle. They
can suck efficiently and digest without pain only
when they sleep soundly. If they are put to the

NERVOUSNESS IN EARLY INFANCY 111

breast after much crying and restlessness, each
meal is followed by flatulence, colic, and renewed
crying. The only effective treatment is to secure
sleep and to carry a slumbering or drowsy infant
to the breast. Then the sucking reflex comes to
its own again, the breast is drained steadily and
well, and digestion proceeds thereafter without
disturbance and during a further spell of sleep.
Two or three times in the day we may be forced, as
meal-time approaches, to cut short the restlessness
of the child by giving a teaspoonful of the following
mixture :

Pot. brom., grs. ij.

Chloral hydrate, gr. i.

Syrup, iUx.

Aq. menth. pip., acl Si-
After this has been taken the child should be
laid down for a quarter of an hour until soundly
asleep. Then very gently he can be carried to his
mother and the nipple inserted. If in this way a
few days of sound sleep and less disturbed digestion
can be secured, the difficulty will in most cases
permanently be overcome. The steadier suction
and more efficient emptying of the breast will
promote a freer flow of milk, and the deeper and
more prolonged sleep will lower greatly the needs
of the child for food. Most of the babies who
show this fault are thin, meagre, and fidgety, and
with some increase of muscular tone. The head is
held up well, the limbs are stiff, the hands clenched,
the abdomen retracted, with the outline of the
recti muscles unusually prominent. If we can

112 THE NERVOUS CHILD

relax this exaggerated state of nervous tension,
if we can help them to become fatter and to put
on weight, the dyspepsia will disappear with the
other symptoms.

It is a question still to be answered whether the
rare conditions of pyloric spasm and pyloric hyper-
trophic stenosis are not further developments of the
same disturbance. Certainly these grave complica-
tions appear most commonly in infants with a
pronounced nervous inheritance, and, as might be
expected, they are more commonly found in private
practice than among the hospital classes.

In passing, we may note that there are babies
who exhibit the opposite fault, and in whom the
contrary regimen must be instituted. Premature
children, children born in a very poor state of
nutrition, and children born with great difficulty,
so that they are exhausted by the violence of their
passage into the world, are apt to show the opposite
fault of extreme somnolence. They are so little
stimulated by their surroundings, and they sleep
so profoundly, that the sucking reflex is not aroused.
Put to the breast they continue to slumber, or after
a few half-hearted sucking movements relapse
into sleep. We must rouse such children by moving
them about and stirring them to wakef ulness before
we put them to the breast.

Once the child has been got to the breast, once
the milk has become firmly established, we have
overcome the first great difficulty which besets us
in the management of nervous little babies, but it
is by no means the last. Restlessness and continual

NERVOUSNESS IN EARLY INFANCY 113

crying must be combated or digestion suffers, and
may show itself in a peculiar form of explosive
vomiting, which betokens the reflex excitability
and unrest of the stomach.

The sense of taste is as acute as all other sensa-
tions. If the child is bottle-fed, the slightest change
in diet is resented because of the unfamiliar taste,
and the whole may promptly be rejected. The
tendency to dyspeptic symptoms is apt to lead to
much unwise changing of the diet, and everything
tried falls in turn into disrepute, until perhaps all
rational diets are abandoned, and some mixture
of very faulty construction, because of its temporary
or accidental success, becomes permanently adopted
— a mixture perhaps so deficient in some necessary
constituent that, if it is persisted with, permanent
damage to the growth of the child results. We
must pay less attention to changes of diet and
explore our management of the child to try and find
how we can make his environment more restful.

It is wise to accustom a nervous child from a very
early age to take a little water or fruit juice from
a spoon every day. Otherwise when breast-feeding
or bottle-feeding is abandoned one may meet with
the most formidable resistance. Infants of a few
months can be easily taught ; the resistance of a
child of nine months or a year may be difficult to
overcome. The difficulty of weaning from the
breast recurs with great constancy in nervous
children. By this time the influence of environ-
ment has become clearly apparent. The child
is often enough already master of the situation,
8

114 THE NERVOUS CHILD

and is conscious of his power. Such children will
sometimes prefer to starve for days together,
obstinately opposing all attempts to get them to
drink from a spoon, a cup, or even a bottle. When
this happens, sometimes the only effective way is
to change the environment and to send the baby
to a grandmother or an aunt, where in new surround-
ings and with new attendants the resistance which
was so strong at home may completely disappear.
When weaning is resented, and difficulties of this
sort arise, it is clear that the mother, whose breast
is close at hand, is at a great disadvantage in com-
bating the child's opposition.

For nervous infants, alas ! broken sleep is the rule.
What, then, is to be done ? It is astonishing to me
that any one who has studied the behaviour of only
a few of these nervous and restless infants should
uphold the teaching that the crying of the young
infant is a bad habit, and that the mother who is
truly wise must neglect the cry and leave him to
learn the uselessness of his appeals. It is true that
the youngest child readily contracts habits good or
bad. Either he will learn the habit of sleep or the
habit of crying. Mercifully the inclination of the
majority is towards sleep. But to encourage
habits of restlessness and crying there is no surer
way than to follow this bad advice and to permit
the child to cry till he is utterly exhausted in body
and in mind. It is unwise always to rock a baby to
sleep; it is also unwise to allow him to scream
himself into a state of hysteria. A quiet, darkened
room, the steady pressure of the mother's hand in

NERVOUSNESS IN EARLY INFANCY 115

some rhythmical movement, will often quiet an
incipient storm. The longer he cries, the more
trouble it is to soothe him. Sleep provokes sleep,
so that often we find restlessness and sound sleep
alternating in a sort of cycle, a good week perhaps
following a bad one. The nurse who is quick to cut
short a storm of crying and to soothe the child again
to sleep is helping him to form habits of sleep.
The nurse who leaves him to cry, believing that
in time he will of his own accord recognise the
futility of his behaviour, is making him form habits
of crying. A rigid routine in sleep is a good thing,
but the routine belongs to the baby, not to the
nurse. The child must be educated to sleep, not
taught to cry. A baby has but little power of
altering his position when it becomes strained or
uncomfortable. He cannot turn over and nestle
down into a new posture. If we watch him wake,
the first stirring may be very gradual, and in a
moment he may fall again to sleep. A few minutes
later he stirs again more strongly, and is wider awake
and for longer. It may only be after a third waking,
by a summation of stimuli, that he is finally roused
and breaks into loud crying. The nurse who is on
the watch, who, sleeping beside him, wakes at the
slightest sound and is quick to turn him over and
settle him into a new position of rest, will probably
report in the morning that the baby has had a good
night. The nurse who lets the child grow wide
awake and start crying loudly, will spend perhaps
many hours before quiet is again restored. Of the
voluntary, purposive crying of infants a little older

116 THE NERVOUS CHILD

I ain not here speaking. Infants in the second
six months are quite capable of establishing a
" Tyranny of Tears " and feeling their power.
Fortunately it requires no great experience to
distinguish one from the other, and to adopt for
each the appropriate treatment.

Again, in elementary teaching upon the manage-
ment of infants stress is laid, rightly enough, upon
the importance of regularity in the times of feeding,
and on the observance in this respect also of a very
strict routine. But in the case of the very nervous
infant a certain latitude should be allowed to an
experienced nurse or mother. We may wreck
everything by a blind adhesion to a too rigid scheme,
which may demand that we leave the child to scream
for an hour before his meal, or that, when at length
he has fallen into a sound sleep after hours of wake-
fulness, we should proceed to wake him.

Symptoms of dyspepsia which are due to con-
tinued nervous excitement demand treatment which
is very different from that which would be appro-
priate to dyspepsia which is due to other causes,
such as overfeeding or unsuitable feeding. The
temporary restriction of food, which is commonly
ordered in dyspepsia from these causes, is very badly
supported by the nervous infant. Hunger invariably
increases the unrest, and the unrest increases the
dyspepsia.

The difficulties of managing a nervous infant are
very real, and call for the most exemplary patience
on the part of the mother and the clearest insight
into the nature of the disturbance.

CHAPTER IX

MANAGEMENT IN LATER CHILDHOOD

IN the early days in the nursery the actions
of the infant, for the most part, follow
passively the traction exercised by nurses and
mothers, sometimes consciously, but more often
unconsciously. We have now to consider a period
when the child becomes possessed of a driving force
of his own, and moves in this direction or that of
his own volition. In this new intellectual move-
ment through life he will not avoid tumbles. He
will feel the restraints of his environment pressing
upon him on all sides, and he will often come
violently in contact with rigid rules and conventions
to which he must learn to yield. From time to
time we read in the papers of some terrible accident
in a picture-palace, or in a theatre. Although there
has been no fire, there has been a cry of fire, and
in the panic which ensues lives are lost from the
crowding and crushing. Yet all the time the doors
have stood wide open, and through them an orderly
exit might have been conducted had reason not
given place to unreason. It is the task of those
responsible for the children's education to guide
them without wild struggling along the paths of

118 THE NERVOUS CHILD

well-regulated conduct towards the desired goal,
influenced not by the emotions of the moment, but
only by reason and a sense of right ; not ignorant
of the difficulties to be met, but practised and
equipped to overcome them.

It is easy thus to state in general terms the
objects of education, and the need for discipline.
To apply these principles to the individual is a task,
the immeasurable difficulty of which we are only
beginning to appreciate with the failure of thirty
years of compulsory education before us. A
recent writer l gives it as his opinion that the aim of
education is to equip a child with ideals, and that
this task should not be difficult, because the lower
savages successfully subject all the members of
their tribe to the most ruthless discipline. Their
lives, he says, " are lived in fear, in restraint, in sub-
mission, in suffering, subject to galling, unreasoning,
unnecessary, arbitrary prohibitions and taboos, and
to customary duties equally galling, unreasoning,
unnecessary, and arbitrary. They endure painful
mutilations, they submit to painful sacrifices. . . .
How are these wild, unstable, wayward, impulsive,
passionate natures brought to submit to such a
rigorous and cruel discipline ? By education ; by
the inculcation from infancy of these ideals. In
these ideals they have been brought up, and to
them they cling with the utmost tenacity." One
might as well contend that it was easy to teach all
men to live the self-denying life of earnest Christians
because some savage tribe was successful in main-
1 The Principles of Rational Education, by Dr. C. A. Meroier.

MANAGEMENT IN LATER CHILDHOOD 119

taining among its members a universal and orthodox
worship of idols. The ideals set before the child
are too high and too complex to be inculcated by
physical force, or even by force of public opinion.
A rigid discipline, with many stripes and with terrible
threats of a still worse punishment in the world to
come, was the almost invariable lot of children
until the last century was well advanced. Yet
has this drastic treatment of young children ful-
filled its purpose ? Were the men of fifty years ago
better conducted and more controlled than the men
of to-day ? In any one family did a greater pro-
portion turn out well ? Is it not true that at least
among the educated classes the relaxation of nursery
and schoolroom discipline which the last fifty years
has seen has been justified by its results ? Is it not
true that the childhood of our grandmothers was
often lived " in fear, in restraint, in submission, in
suffering subject to galling, unreasoning, unnecessary,
arbitrary prohibitions and taboos, and to customary
duties equally galling, unreasoning, unnecessary,
and arbitrary." And though perhaps the grand-
mothers of most of us may not have been much the
worse for all this discipline, is it not true that of the
little brothers who shared the nursery with them a
surprising number broke straightway into dissipa-
tion when the parental restraints were removed ?
If we are to teach a child to be gentle to the weak
it is not wise to beat him. The qualities which we
wish him to possess are not more subtle than the
means by which we must aid him to their possession.
Education comprises physical, mental, and moral

120 THE NERVOUS CHILD

training. In earlier times physical strength and
the power to fight well, alone were prized and were
the chief objects to be gained in the education of
youth. Later, under the stress of intellectual
competition for success in life, mental acquire-
ments have come to occupy the first place. We are
only now learning to lay emphasis upon the supreme
need for moral training. Not that it is possible to
separate the sum of education into its constituent
parts, and to regard each as distinct from the others.
That many men of great intellectual activity, and
many men pre-eminent for their moral qualities
have harboured a great brain or a noble character
in a weakly or deformed body, forms no argument
to disprove the general rule that a healthy, vigorous
physique is the only sure foundation upon which
to build a highly developed intellect and a stable
temperament. In childhood the intimate connec-
tion between vigour of mind and vigour of body is
almost always clearly shown. A child with rickets,
unable to exercise his body in free play, as a rule
shows a flabbiness of mind in keeping with his
useless muscles and yielding bones. Such children
talk late, are infantile in their habits and ways of
thought, and are more emotional and unstable than
healthy children of the same age. The connection
between bodily ailments and instability of nervous
control is even more clearly seen in the frequent
combination of rheumatism and chorea. A very
high proportion of older children suffering from the
graver neuroses, such as chorea, syncopal attacks,
phobias, tics, and so forth, show defective physical

MANAGEMENT IN LATER CHILDHOOD 121

development. Scoliosis, lordosis, knock-knee, flat
foot, pigeon chest, albuminuria, cold and cyanosed
extremities, are the rule rather than the exception.
If the body of the child is developed to the greatest
perfection of which it is capable we shall not often
find a too sensitive nervous system. The boy of
fine physique may have many faults. He may be
bad-tempered or untruthful or selfish, but such
faults as he has are as a rule more primitive in type,
more readily traced to their causes, and more easy
to eradicate than the faults which spring from that
timidity, instability, and moral flabbiness which has
so often developed in the lax delicate child reared
softly in mind and body.

PHYSICAL TRAINING

Children thrive best in the healthy open-air life
of the country, and if there is any tendency to
nervous disturbances the need for this becomes
insistent. Physical training, further, includes the
manual education of the child. The system of
child-training advocated by Dr. Montessori is based
upon the cultivation of tactile sensations and the
development of manual dexterity. Exercises such
as she has devised have an immediate effect in
calming the nervous system and in changing the
restless or irritable child into a self -restrained and
eager worker. Lord Macaulay, whose phenomenal
memory as a child has become proverbial, was so
extraordinarily unhandy that throughout life he
had considerable difficulty in putting on his gloves,

122 THE NERVOUS CHILD

while he had such trouble with shaving that on his
return from India there were found in his luggage
some fifty razors, none of which retained any edge,
and nearly as many strops which had been cut to
pieces in his irritated and ineffectual efforts. If we
teach a child manual dexterity it is an advantage
to him, because manual dexterity is seldom asso-
ciated with restlessness and -irritability of mind.
To excel in some handicraft not only bespeaks the
possession of self-control, it helps directly to culti-
vate it. The teaching of Froebel and Montessori
holds good after nursery days are over.

MENTAL TRAINING

Mental training enables the child to retain facts
in his memory, to obtain information from as many
sources as possible, to understand and piece them
together, and finally to reach fresh conclusions
from previously acquired data. So far as is possible
the teacher must satisfy the natural desire to know
the reason of things. It must be his endeavour to
prevent the child from accepting any argument
which he has not fully understood, and which, as a
result, he is able not to reconstruct but only to
repeat. Mental work which is slovenly and per-
functory is as harmful to the child's education as
mechanical work which is bungled and ineffective.
Taking advantage of his natural aptitudes, his
interest should be developed and extended in every
way possible. Tasks which are accomplished
without enthusiasm are labour expended in vain,

MANAGEMENT IN LATER CHILDHOOD 123

because the knowledge so acquired is not assimi-
lated and adds nothing to the child's mental growth.
There should be no sharp differentiation between
work and play.

MORAL TRAINING

Moral training depends upon the forc^ of jsx ample
rather than of precept. Parents must be scrupu-
lously just and truthful to the child, for his quick
perception will detect the slightest deceit, and the
evil impression made on his mind may be lasting.
They must confidently expect conduct from him
of a high moral standard, and be careful at this
early age to avoid the common fault of giving a
dog a bad name. If it is said on all sides that a
child has an uncontrollable temper, is an inveterate
grumbler, is lacking in all power of concentration,
or has a tendency to deceit, it is likely that the child
will act up to his reputation. He comes in time to
regard this failing of his as part of himself just as
much as is the colour of his hair or the length of his
legs. It may be said of a schoolboy that he shows
no aptitude for his work. Term by term the same
report is brought home from school, and each serves
only to confirm the boy in his belief that this failing
is part of his nature, and that no effort of his own
can correct it. If one subject only has escaped the
condemnation of his master, then it may be to that
study alone that he returns with zest and enjoy-
ment. Spendthrift sons are manufactured by those
fathers who many times a day proclaim that the
boy has no notion of the value of money.

124 THE NERVOUS CHILD

And so with children ! Parents must take it for
granted that they will display all the virtues they
desire in them. They must trust to their honour
always to speak the truth, and always to do their
best in work or play whether they are with them
or not. Again and again the children will fail
and their patience will be tried to the utmost. They
must explain how serious is the fault, and for the time
being their trust may have to be removed ; but with
the promise of amendment it must again be fully
restored and the lapse completely forgotten. If
the child feels he is not trusted he ceases to make any
effort, and lapse will succeed lapse with increasing
frequency.

In efforts at moral training there is often too great
an emphasis laid upon negative virtues. It is wrong
to do this : to do that is forbidden. Children
cannot progress by merely avoiding faults any
more than a man may claim to be an agreeable
companion at table because he does not eat peas
with a knife or drink with his mouth full. There
must be a constant effort to achieve some positive
good, to acquire knowledge, to do service, to take
thought for others, to discipline self, and the parent
will get the best result who is comparatively blind
to failure but quick to encourage effort and to
appreciate success. When the child knows well
that he is doing wrong, exhortation and expostula-
tion are usually of little avail if repeated too often,
and serious talks should only take place at long
intervals.
We know how effective the so-called " thera-

MANAGEMENT IN LATER CHILDHOOD 125

peutic conversation " may be in helping some
overwrought and nervously exhausted man or
woman to regain peace of mind and self-control.
After an intimate conversation with a medical man
who knows how to draw from the patient a free
expression of the doubts, anxieties, and fears which
are obsessing him, many a patient feels as though
he had awakened in that instant from a night-
mare, and passes from the consulting-room to find
his troubles become of little acount. Not a few
patients return to be reassured once more, and de-
rive new strength on each occasion. Yet visits such
as these must be infrequent or they will lose their
power. Now, just as the physician is well aware
that his intervention if too frequently repeated
will lose its effect, so the parent must be chary of too
frequent an appeal to the moral sense of the child.
At long intervals opportunity may be taken with all
seriousness to set before the child ideals of conduct,
to speak to him of the meaning of character and of
self-discipline, and of the standards by which we
judge a man or woman to be weak and despicable,
or strong and to be admired. The effect of such
an intimate conversation, never repeated, may
persist throughout life. Constantly reiterated ap-
peals, on the other hand, do more harm than good.
To tell a child daily that he is " breaking mother's
heart," or that he is " disappointing his father,"
is to debase the moral appeal and deprive it of its
strength.

For everyday use it is best to cultivate a manner
which can indicate to the child that he is for the

126 THE NERVOUS CHILD

moment unpopular, but which at the same time
denies to the small sinner the interest of attempt-
ing his own defence. On the other hand, should the
child be reasonably in doubt as to the nature of his
offence we must spare no trouble in explaining it to
him. Punishment will be most effective when the
child is convinced that he is rightly convicted. If
it is to act as a real deterrent, he must agree to be
punished — a frame of mind which, if it can be pro-
duced, may be welcomed as a sure sign that training
is proceeding along the right lines.

By physical training, mental training, and moral
training the child's character is formed and self-
discipline is developed. With the child of neuro-
pathic disposition and inheritance matters may not
proceed so smoothly. Reasoning and conduct
may be alike faulty, and the nervous disturbances
may even cause detriment to the physical health.
Not that the nervous child requires an environment
different from that of the normal child. The diffi-
culties which the parents will encounter and the
problems which must be solved differ not in kind
but in degree. An error of environment which is
without effect in the normal child may be sufficient
to produce disastrous results in the neuropathic.

It must be granted that there are some unfortunate
children in whom the moral sense remains absent
and cannot be developed — children who steal and
lie, who seem destitute of natural affection, or who
appear to delight in acts of cruelty. These moral
degenerates need not be considered here. Serious
errors of conduct, however, in children who are net

MANAGEMENT IN LATER CHILDHOOD

degenerate or imbecile, frequently arise directly
from faults of management and can be controlled
by correcting these faults. Suppose, for example,
that a child is found to have taken money not his
own. The action of the parents faced with this
difficulty and disappointment will determine to
a great extent whether the incident is productive
of permanent damage to the child's character. The
peculiar circumstances of each case must be con-
sidered. For example, the parent must bear in
mind the relation in which children stand to all
property. The child possesses nothing of his own ;
everything belongs in reality to his father and
mother, but of all things necessary for him he has
the free and unquestioned use. Unless his attention
has been specially directed to the conception of
ownership and the nature of theft, he may not have
reasoned very closely on the matter at all. Very
probably he knows that it is wrong to take what
is not given him, but he does not regard helping
himself to some dainty from a cupboard as more
than an act of disobedience to authority. He may
have imbibed no ideas which place the abstraction
of money from a purse belonging to his parents on
a different plane, and which have taught him to
regard such an action as especially dishonourable
and criminal. Finally, a child who, undetected,
has more than once taken money belonging to his
father and mother, may pass without much thought
to steal from a visitor or a servant. To deal with
such a case effectively, to ensure that it shall never
happen again, requires much insight. If the father,

128 THE NERVOUS CHILD

shocked beyond measure to find his son an incipient
criminal, differing in his guilt in no way from boys
who are sent to reformatories as bad characters,
convinces the child that although he did not realise
it, he has shown himself unworthy of any further
trust, untold harm will be done. Almost certainly
the child will act in the future according to the
suggestions which are thus implanted in his mind.
If the household eyes him askance as a thief, if
confidence is withdrawn from him, he sees himself
as others see him and will react to the suggestions
by repeating the offence. The seriousness of what
he has done should be explained to him, and after
due punishment he must be restored completely
and ostentatiously to absolute trust. Only by
showing confidence in him can we hope to do away
with the dangers of the whole incident. To in-
culcate good habits and encourage good behaviour
we must let the child build up his own reputation
for these virtues. It need not make him priggish
or self-satisfied if parents let him understand that
they take pride in seeing him practise and develop
the virtue they aim at. For example, it is desired
above all that he should always speak the truth.
Then they must ostentatiously attach to him the
reputation of truthfulness and show their pride in
his possessing it. If he falls from grace they must
remember that he is still a child, and that if that
reputation is lightly taken from him and he is
accused of a permanent tendency towards untruth-
fulness, he is left hopeless and resigned to evil.
Let any mother make the experiment of presenting

MANAGEMENT IN LATER CHILDHOOD 129

to her child in this way a reputation for some
particular virtue. For example, if an older child
shows too great a tendency to tease and interfere !
with the younger children, let the mother seize '
the first opportunity which presents itself to applaud
some action in which he has shown consideration ;
for the others. Let her comment more than once
in the next few days on how careful and gentle the
older child is becoming in his behaviour to the little
ones, and in a little the suggestion will begin to
act until the transformation is complete. If, on
the other hand, the mother adopts the opposite
course and rebukes the child for habitual unkindness,
she will be apt to find unkindness persisted in.
The criminal records of the nation show too often
the truth of the saying that " Once a thief always
a thief." Deprived of his good repute, man loses
his chief protection against evil and his incentive
to good.

The inability of a child — and especially of a
nervous and sensitive child — to form conceptions
of his own individuality except from ideas derived
from the suggestions of others, gives us the key to
our management of him and to our control of his
conduct. He has, as a rule, a marvellously quick
perception of our own estimate of him, and uncon-
sciously is influenced by it in his conception of his
own personality, and in all his actions. Parents
must believe in his inherent virtue in spite of all
lapses. If they despair it cannot be hid from the
child. He knows it intuitively and despairs also.
It is then that they call him incorrigible. If it
9

130 THE NERVOUS CHILD

happens that one parent becomes estranged from
the child, despairs of all improvement, and sees in
all his conduct the natural result of an inborn dis-
position to evil, while the other parent holds to the
opinion that the child's nature is good, and to the
belief that all will come right, then often enough the
child's conduct shows the effect of these opposite
influences. In contact with the first he steadily
deteriorates, affording proof after proof that judg-
ment against him has been rightly pronounced.
In contact with the other, though his character
and conduct are bound to suffer from such an
unhappy experience, he yet shows the best side
of his nature and keeps alive the conviction that he
is not all bad.

The force of suggestion is still powerful to control
conduct and determine character in later child-
hood. The impetus given by the parents in this
way is only gradually replaced by the driving power
of his own self-respect — a self-respect based upon self-
analysis in the light of the greater experience he has
acquired.

CHAPTER X
NERVOUSNESS IN OLDER CHILDREN

IN older children the line which separates
naughtiness, fractiousness, and restlessness
from definite neuropathy begins to be more marked.
The nature of the young child, taking its colour
from its surroundings, is sensitive, mobile, and in-
constant. With every year that passes, the normal
child loses something of this impressionable and
fluid quality. With increasing experience and with
a growing power to argue from ascertained facts,
character becomes formed, and if tempered by
discipline will come to present a more and more
unyielding surface to environment, until finally it
becomes set into the stability of adult age.

We may perhaps, with some approach to truth,
look upon the adult neurotic as one whose
character retains something of the impressionable
quality of childhood throughout life, so that, to the
last, environment influences conduct more than is
natural.

All the emotions of neurotic persons are ex-
aggerated. Disappointments over trifles cause
serious upsets ; grief becomes overmastering.
Violent and perhaps ill - conceived affection for

182 THE NERVOUS CHILD

individuals is apt to be followed by bitter dislike
and angry quarrelling. On the physical side, sense
perception is abnormally acute, and many sensations
which do not usually rise up into consciousness at
all become a source of almost intolerable suffering.
To these most unhappy people summer is too hot
and winter too cold ; fresh air is an uncomfortable
draught, while too close an atmosphere produces
symptoms of impending suffocation.

In some neurotics there is an excessive in-
terest in all the processes of the life of the body,
and when attention is once attracted to that which
usually proceeds unconsciously, symptoms of dis-
comfort are apt to arise. Thus so simple an act
as swallowing may become difficult, or for the
time being impossible. To breathe properly and
without a sense of suffocation may seem to require
the sustained attention of the patient ; or again,
the voice may be suddenly lost.

More commonly, perhaps, neuropathy exhibits
itself in an undue tendency to show signs of fatigue
upon exertion of any sort, mental or physical.
Sustained interest in any pursuit or task becomes
impossible. Nameless fears and unaccountable
sensations of dread establish themselves suddenly
and without warning, and may be accompanied
on the physical side by palpitation, flushing, head-
ache, or acute digestive disturbances.

All these manifestations are best controlled by
selecting a suitable environment, and as a rule
the character of the environment is determined by
the temperament and disposition of those who live

NERVOUSNESS IN OLDER CHILDREN 138

in close contact with the patient. Like the tiny
children with whom we have dealt so far, the
behaviour of neuropathic persons is subject wholly
to the direction of stronger and more dominant
natures. With faulty management at the hands
of those around them, no matter how loving and
patient these may be, the conduct of the neurotic
tends to become abnormal.

In children beyond earliest infancy we recognise
a gradual approach to the conditions of adult life.
Fractiousness and naughtiness, ungovernable fits
of temper, inconsolable weeping and inexplicable
fears should disappear with early childhood even if
management has not been perfect. If they persist
to older childhood we shall find in an increasing
percentage of cases evidence of definite neuropathic
tendencies which urgently call for investigation
and for a precise appreciation of the nature of the
abnormality. It may be that the only effective
treatment is that which we recognise as essential
in the grosser mental disturbances — removal from
the surroundings in which the abnormal con-
duct has had free play, and separation from
the relatives whose anxiety and alarm cannot be
hidden.

In young nervous children fear is the most
prominent psychical symptom. The children are
afraid of everything strange with which they
come in contact. They are afraid of animals, of
a strange face, or an unfamiliar room. Older
children usually manage to control themselves,
suppress their tears, and prevent themselves from

134 THE NERVOUS CHILD

crying out, but it is nevertheless easy to detect
the struggle.

Often we find those distressing attacks to which
the name " night- terrors " has been given. The child
wakes with a cry,— usually soon after he has gone to
sleep, — sits up in bed and shows signs of extreme
terror, gazing at some object of his dreams with
wide-open startled eyes, begging his nurse or
mother to keep off the black dog, or the man, or
whatever the vision may be. Even after the light
is turned up and the child has been comforted, the
terror continues, and half an hour may elapse
before he becomes quiet and can be persuaded
to go back to bed. In the morning as a rule he
remembers nothing at all.

Phobias of all sorts are common in nervous
children, and result from a morbid exaggeration of
the instinct for self-preservation. Some cannot bear
to look from a height, others grow confused and
frightened in a crowd ; dread of travelling, of being
in an enclosed space such as a church or a school-
room, or of handling sharp objects may develop
into a constant obsession. I have known a little
girl who was seized with violent fear whenever
her father or mother was absent from the house,
and she would stand for hours at the window in
an agony of terror lest some harm should have
befallen them. As if with some strange notion of
propitiating the powers of darkness these children
will often constantly perform some action and will
refuse to be happy until they have done so. The
same little girl who suffered such torments of anxiety

NERVOUSNESS IN OLDER CHILDREN 135

in her parents' absence would always refuse to
go to bed unless she had stood in turn on all the
doormats on the staircase of her home. Other
children feel themselves forced to utter certain
words or to go through certain rhythmical move-
ments. They fully understand that the fear in
their mind is irrational and devoid of foundation,
but they are unable to expel it. Often it is hugged
as a jealous secret, so that the childish suffering is
only revealed to others years afterwards, when adult
age has brought freedom from it. We will do
well to try by skilful questioning to gain an insight
into the mental processes of a child when we find
him showing an uncontrollable desire to touch
lamp-posts or to stand in certain positions ; or
when he develops an excessive fear of getting dirty,
or is constantly washing his hands to purify them
from some fancied contamination.

The treatment of all these symptoms calls for
much insight. The child's confidence must be
completely secured, and he must be encouraged to
tell of all his sensations and of the reasons which
prompt his actions. The nervous child has a
horror of appearing unlike other children, and will
suffer in silence. If his troubles are brought into
the light of day with kindness and sympathy they
will melt before his eyes. Even night-terrors are,
as a rule, determined by the suppressed fears of
his waking hours. If they are provoked by his
experiences at school, by the fear of punishment
or by dismay at a task that has proved beyond his
powers, he should be taken away from school for

136 THE NERVOUS CHILD

the time being. Night-terrors are said to be aggra-
vated by nasal obstruction due to adenoid vegeta-
tions. Clothing at night should be light and porous,
and particular attention should be paid to the need
for free ventilation.

We have spoken in an earlier chapter of the
trouble sometimes experienced in inducing a
nervous child to go to sleep. In older children
insomnia is common enough. Even when sleep
comes it may be light and broken, as though the
child slept just below the surface of consciousness
and did not descend into the depths of sound and
tranquil slumber. We have often noticed how
different is the estimate of the patient from that
of the nurse as to the number of hours of sleep
during the night. The sick man maintains that he
has hardly slept at all, whilst the nurse, drawing
us aside, whispers in our ear that he has slept
most of the night. In estimating sleep we have
to consider not only its duration, but also its depth,
and the patient who denies that he has slept at all
has lain perhaps half the night with an active
restless brain betwixt sleep and wakefulness. Often
enough when he comes to consider in the morning
the problems that vexed his soul at midnight, he
is quite unable to recall their nature, and recognises
them as the airy stuff that dreams are made of.
Although in a sense asleep he may have retained a
half-consciousness of his surroundings and a sense
of despair at the continued absence of a sounder
sleep.

With nervous children we are apt to find sleep

NERVOUSNESS IN OLDER CHILDREN 137

which is of little depth and which constantly shows
evidence of a too-active brain. The body is tossed
to and fro, words are muttered, and the respiration
is hurried and with a change in rhythm, because
there is no depth of anaesthesia. The body still
responds to the impulses of the too-active brain.
From the nature of his dream — as shown by chance
words overheard — we may sometimes gather hints
to help us to find where the elements of unrest in
his daily life lie. Sleep-walking is only a further
stage in this same disorder of sleep, in which the
dream has become so vivid that it is translated
into motor action.

If a child begins to suffer from active sleepless-
ness we must not make the mistake of urging him
to sleep. He is no more capable than we are our-
selves of achieving sleep by an effort of will power.
To urge him to sleep is likely to cause him to keep
awake because we direct his attention to the diffi-
culty and make him fear that sleep will not come.
If he understands that all that he needs is rest,
he will probably fall asleep without further trouble.

Day-dreams also may become abnormal, and tell
of an unduly nervous temperament. Any one who
watches a little child at play will realise the strength
of his power of imagination. The story of Red
Riding Hood told by the nursery fire excites in the
mind of the child an unquestioning belief which is
never granted in later life to the most elaborate
efforts of the theatre. All this imaginative force is
natural for the child. It becomes abnormal only
when things seen and acts performed in imagination

138 THE NERVOUS CHILD

are so vivid as to produce the impression of actual
occurrences, and when the child is so under the
sway of his day-dreams that he fails to realise the
difference between pretence and reality. Imagina-
tion which keeps in touch with reality by means of
books and dolls and toys is natural enough. Not
so imagination which leads to communion with
unseen familiars or to acts of violence due to the
organisation of " conspiracies "or " robber bands "
amongst schoolboys.

If evidence of abnormal imagination appears, the
child must be kept in close touch with reality. We
must give him interesting and rational occupation,
such as drawing, painting, the making of collections
of all sorts, gardening, manual work, and so forth.
In older children we must especially supervise the
reading.

In many nervous children we find a faulty con-
tact with environment, so that instead of becom-
ing interested in the thousand-and-one happenings
of everyday life and experiences, they become
introspective and self-conscious. As a result, sen-
sations of all sorts, which are commonly insufficient
to arouse the conscious mind, attract attention and,
rising into consciousness, occupy the interest to
the exclusion of everything else. The conscious
mind is not capable of being occupied by more than
one thing at a time. If attention is concentrated
upon external matters, bodily sensations, even
extreme pain, may pass altogether unnoticed.
The Mohawk, Lord Macaulay tells us, hardly feels
the scalping-knife as he shouts his death song.

NERVOUSNESS IN OLDER CHILDREN 139

The soldier in the excitement of battle is often
bereft of all sense of pain. On the other hand, the
patient who is morbidly self-conscious becomes
oblivious of his surroundings while he suffers
intensely from sensations which are usually not
appreciated at all. Self-conscious children will
complain much of breathlessness and a sense of
suffocation, of headache, of palpitation, of intoler-
able itching, of the pressure of clothing, or of
flushing and a sense of heat. Excessive intro-
spection influences their conduct in many ways.
At children's parties, for example, they will be found
wandering about unhappy, dazed and unable to
feel the reality of the surroundings which afford
such joy to the others ; or they may be anxious
to join in play, but finding themselves called upon
to take their turn are apt to stand helplessly in-
active, or to burst into tears. At school, though
they may be really quick to learn, they will often
be found oblivious of all that has gone on around
them, not from stupidity, but from inability to
dissociate their thoughts from themselves and to
concentrate attention upon the matter in hand.
In such a case we must aim at developing the child's
interest to the exclusion of this morbid introspec-
tion. Taking advantage of his individual aptitude,
we must strengthen his hold upon externals in
every way possible, and we must explain to him the
nature of his failing and teach him that his salva-
tion lies in cultivating his capacity for paying
attention to things around him and developing an
interest in suitable occupations.

140 THE NERVOUS CHILD

Fainting fits are not uncommon amongst nervous
children from about the sixth year onwards, and
are apt to give rise to an unwarranted suspicion of
epilepsy. In other cases fears have been aroused
that the heart may be diseased. In children who
faint habitually the nervous control of the circula-
tion is deficient. We notice that when they are
tired by play, or when they are suffering from the
reaction that follows excitement of any sort, the
face is apt to become pale, and dark lines may
\ appear under the eyes. Yet there may be no true
anaemia present : it is only that the skin is poorly
supplied with blood for the moment. After a little
rest in bed, or under the influence of a new excite-
ment, the colour returns, and the tired look vanishes.
If children of this type are made to stand motionless
for any length of time, and if at the same time
there is nothing to attract their interest or atten-
tion— a combination of circumstances which un-
happily is sometimes to be found during early
morning prayers at school — the want of tone in the
blood vessels may leave the brain so anaemic that
fainting follows. The first fainting attack is a con-
siderable misfortune, because the fear of a recur-
rence is a potent cause of a repetition. Standing
upright with the body at rest and the mind vacant,
the circulation stagnates, the boy's mind is attracted
by the suggestion, he fears that he will faint as he
has done before, and he faints. Schoolmasters are
well aware that if one or two boys faint in chapel
and are carried out, the trouble may grow to the
proportion of a veritable epidemic. It is important

NERVOUSNESS IN OLDER CHILDREN 141

that this habit of fainting should be combated not
only by general means to improve the tone of the
body and circulation, but also by taking care that
the child understands the nature of the fainting
fit, and the part which association of ideas plays
in producing it. Disease of the heart seldom gives
rise to fainting.

The same vasomotor instability which shows
itself in the tendency to syncopal attacks is ap-
parent in many other ways. Sudden sensations of
heat and of flushing, equally sudden attacks of
pallor, coldness of the extremities, abundant per-
spiration,— raising in the mind of the anxious mother
the fear of consumption, — and excessive diuresis
are common accompaniments. A further group of
symptoms is provided by the extreme sensibility
of the digestive apparatus. Dyspepsia, hyper-
sesthesia of the intestinal tract, viscero - motor
atonies and spasms, and anomalies of the secretions,
whether specific like that of the gastric juice or
indifferent like that of the nasal, pharyngeal, gastric,
and intestinal mucus, are all of common occurrence.
Whenever the nervous child is subjected to any
exhausting experience, any excitement, pleasurable
or the reverse, or any undue exertion, whether
mental or physical, one may note the subsequent
gastro-intestinal derangement, including even a
coating of the tongue. The slightest deviation from
the usual diet, the most trivial fatigue, a chill of the
body, even a change in the temperature of the food
may set loose the most extreme reactions in the
gastro-intestinal tract — motor, sensory, or secretory.

142 THE NERVOUS CHILD

It is not an accident that so often the mucous
diarrhea a, which may have afflicted an excitable
child in London for many months, and which a visit
to the seaside, with all its healthy activities, may
seem to have completely cured, relapses within a
day or two of the return to the restricted environ-
ment and uninteresting routine of life in London.
The child who was happy and busy and at peace
with himself, at play in the open air, resents the
sudden cessation of all this, and the nervous unrest
returns. To attempt treatment by dietetic restric-
tions alone is to deal only with a symptom. The
gastro-intestinal reactions are so violent that the
parents are generally voluble on the subject of the
many foods which cannot be taken and the few
which are not suspect. To prescribe rigid tables
of diet is to add to the alarm of the mother, and to
sustain her in the belief that the child is in daily
danger of being poisoned by a variety of common
articles of diet. Only by lowering the excitability
of the nervous system, by occupying the mind and
giving strength to the child's powers of control
can we effectively combat the hypersesthesia. If
necessary the personnel of the management of the
child will have to be altered. There may be no
other way to achieve certain and rapid improve-
ment in a condition which is causing grave danger
to the child and very genuine distress and suffering
to the parents. A violent reaction to intoxications
of all sorts is a further stigma of nervous instability.
Sudden and even inexplicable rises of temperature
are frequent complaints, and the constitutional

NERVOUSNESS IN OLDER CHILDREN 148

effects of even trivial local infections are apt to be
disproportionately great.

Fatigue is easily induced and is exhibited in all
varieties of activity — mental, physical, or visceral.
Mental work may produce fatigue with extreme
readiness even although the quality of the work
may remain of a high standard. To Darwin and to
Zola work for more than three hours daily was an
impossibility, and yet their work done under these
restrictions excites all men's admiration. The
palpitation and breathlessness which follows upon
trivial exertion, such as climbing a flight of stairs,
is a good example of visceral fatigue.

Among adult neuropaths we recognise the harm
which may be done by unwise speeches on the part
of relatives, or still more on the part of doctors.
A chance word from a doctor or nurse off their
guard for the moment will implant in the minds of
many such a person the unyielding conviction that
he or she is suffering from some gastric complaint,
from some cardiac affection, or from some constric-
tion of the bowel. It may take the united force
of many doctors to uproot this pathological doubt
which was implanted so easily and so carelessly.
The medical student is notoriously prone to recog-
nise in himself the symptoms of ailments which he
hears discussed. Little children, too, are apt to
suffer in the same way. How much illness could
be avoided if mothers would cease to erect some
single manifestation of insufficient nervous control
into a local disorder which becomes an object of
anxiety to the child and to the whole household.

144 THE NERVOUS CHILD

Undue liability to fatigue, irritability, instability,
lack of control over the emotions, extreme suggesti-
bility, prompt and exaggerated reactions to toxins
of all sorts, excessive vasomotor reactions and
anomalies of secretion, weakness of the gastro-
intestinal apparatus — these, and many other
symptoms, are of everyday occurrence in the ner-
vous child. To discuss them more fully would
be to pass too far from our nursery studies into a
consideration of psychological medicine.

CHAPTER XI

NERVOUSNESS AND PHYSIQUE

IT has already been said that symptoms of
nervousness are often accompanied by faults
in the physical development of the child. The
defects may assume so many forms as to make any
attempt at description very difficult. Nevertheless,
certain types of physical defect present themselves
with sufficient frequency, in combination with
neurosis, to merit a detailed description. For
example, we recognise a type of nervous child which
is marked by a persistence into later childhood of
certain infantile characteristics of the build and
shape of body. Further, we meet with a group
characterised by a special want of tone in the
skeletal muscles, by lordosis, by postural albumin-
uria, and by abdominal and intestinal disturbances
of various sorts. We recognise also the rheumatic
type of child with a tendency to chorea, and in con-
trast to this a type with listlessness, immobility, and
katatonia. Lastly, in a few children, in boys as
well as in girls, we may meet with cases of hysteria.1

1 If we accept as hysterical all symptoms which are produced
by suggestion and which can be removed by suggestion, we may
correctly speak of a physiological hysteria of childhood, which in-
cludes a very large number of the symptoms discussed. The term
is used here in its older more limited sense.

10

146 THE NERVOUS CHILD

(1) A GROUP WITH PERSISTENCE OF CERTAIN
INFANTILE CHARACTERISTICS

During the first year or eighteen months of life,
the rounded infantile shape of body persists. The
limbs are short and thick, the cheeks full and
rounded, the thorax and pelvis are small, the ab-
domen relatively large and full. The great adipose
deposit in the subcutaneous tissue serves as a depot
in which water is stored in large amounts. In the
healthy child of normal development by the end
of the second year a great change has taken place.
The shape of the body has become more like that
of an adult in miniature. The limbs have grown
longer and slimmer. The thorax and pelvis have
developed so as to produce relatively a diminution
in the size of the abdomen. The body fat is still
considerable, but no longer completely obliterates
the bony prominences of the skeleton. Delay in
this change, in this putting aside of the infantile
habit of body, is commonly associated with a
corresponding backwardness in the mental de-
velopment. Such children walk late, talk late,
learn late to feed themselves, to bite, and to
chew effectively. Watery and fat, they carry with
them into later childhood the infantile suscepti-
bility to catarrhal infections of the lung, bowel,
skin, etc., and they are apt to suffer, in consequence,
from a succession of pyrexial attacks. Nasal
catarrh, bronchitis, otitis media, enteritis, eczema,
urticaria papulata, are apt to follow each other in
turn, giving rise in many cases to a persistent en-

NERVOUSNESS AND PHYSIQUE 147

largement of the corresponding lymphatic glands.
The effect upon the different tissues of the body
of these repeated infections is very various. We
are probably not wrong in attributing the failure to
develop and the persistently infantile appearance
to a prejudicial effect upon the various ductless
glands in the body. The condition is associated
with an excessive retention of fluid in the body,
secondary in all probability to alterations in the con-
centration and distribution of the saline constituents
of the body. A rapid excretion of salts may be
followed by a correspondingly speedy dehydration
of the body, a retention of salts by a sudden increase
of weight. The parathyroid glands are probably
closely concerned in regulating the retention and
excretion of salts, and especially of calcium, a cir-
cumstance which becomes of significance when we
remember how frequently rickety changes, tetany,
and other convulsive seizures form part of the
clinical picture which we are now considering.
While it is difficult to determine the effect of re-
peated infections upon the functions of the endocrine
glands, we have clear evidence of the deleterious
influence upon almost all the tissues of the body,
the functioning of which it is more easy to estimate.
For example, the cells of the skin and of the mucous
membranes which happen to be visible to the eye
show clear evidence of diminished vitality and in-
creased vulnerability. Physiological stimuli, in-
capable of producing any visible reaction in healthy
children, habitually determine widely spread and
persistent inflammatory reactions. For example,

148 THE NERVOUS CHILD

the licking movements of the tongue at the corners
of the mouth produce the little unhealthy fissures
which the French call perleche. The physiological
stimulus of the erupting tooth is capable of causing
a painful irritation of the gum, so that the child is
said to suffer from teething, accompanied, it may
be, and the association is significant, by "teething
convulsions." The irritation of the urine produces
rawness and excoriation of the skin of the prepuce,
contact with intestinal contents not in themselves
very abnormal, an intractable dermatitis of the
buttocks or a persistent diarrhoea and enteral
catarrh. Improvement in the general health, the
result of the cessation for the time being of the
recurrent infections, perhaps consequent upon im-
proved hygienic conditions, always determines the
rapid disappearance of all these accompaniments of
the general diminution of tissue vitality.

The muscular system and the bones are commonly
also involved, so that rickety changes are often
found in these infantile and watery children. In
early childhood the processes of calcification and
decalcification proceed side by side and with great
rapidity, and in health there is always a balance on
the side of the constructive process. In the children
whom we are now considering, saturated as they
are, from time to time, with the toxins resulting from
repeated infection, ossification may be so interfered
with as to cause softening and bending, with the
evolution of a state of rickets. Between bone and
muscle, too, we find a close relationship. We do
not find powerful muscles with softened bone,

NERVOUSNESS AND PHYSIQUE 149

nor flabby muscle with rigid and well-formed
bone.

In the nervous system, the conditions are some-
what different. In skin, in bone, and in muscle
new cell elements are constantly being formed, and
the life of the individual cell is relatively short. In
the nervous system, on the other hand, the individual
cells are long lived. Their life-history may even be
coterminous with that of the individual, and if
destroyed they are not replaced. Nevertheless,
they do not escape undamaged in the general dis-
turbance. In a deprivation of calcium we have, in
all probability, the explanation of the increased
irritability of peripheral nerves and of the tendency
to convulsive seizures of all sorts which is a common
accompaniment of the condition. Convulsions,
laryngismus stridulus, tetany, or carpopedal spasm
are all frequently met with. In crying, the children
hold their breath to the point of producing extreme
cyanosis, ending, as the spasm relaxes, with a crowing
inspiration, which resembles and yet differs in tone
from both the whoop of whooping-cough and the
crowing inspiration of croup.

Apart, however, from this tendency to convulsive
seizures the nervous system of these children is
abnormal. As a rule they are excitable, and develop
late the power to control their emotions. Lagging
behind in physical development and in the capacity
to interest themselves in the pursuits of normal
children, their emotional state remains that of a
much younger child. In the infant classes at
schools they are recognised as dullards, learning

150 THE NERVOUS CHILD

slowly, speaking badly, and lacking co-ordination
in all muscular movements.

The clinical picture so depicted is encountered
with extreme frequency among the children of the
poor in our large cities. To find a name for the
condition is no easy matter. To call it " rickets "
is to place an undue emphasis upon the bony changes
which, though common, are by no means invariable.
Elsewhere I have suggested the name status
catarrhalis, on an analogy with the name status
lymphaticus, which in the post-mortem room is
used to describe the secondary overgrowth of
lymphatic tissue which is found in these catarrhal
children. In the present connection it is of interest
to us to note how commonly the nervous system
is involved in the general picture and the frequency
both of convulsive disorders and of neuropathy.

The nervous symptoms of both sorts are to be
allayed only by improving the general hygiene of the
child and raising its resistance against infection.
A sufficiency of fresh air and of sunlight, and a
management which encourages independence of
action in the child, are both necessary. The diet is
of the first importance. It should be sufficient, and
no more than sufficient, to cover the physiological
needs of the child for food. The majority of these
children have enormous appetites, and excess of
food, and especially of carbohydrate food, plays
some part in the production of the disturbance.
We must guard against overfeeding, against want of
air and want of exercise, and against those errors of
management described in previous chapters, which

NERVOUSNESS AND PHYSIQUE 151

produce the maximum of disturbance in this type
of child.

(2) A GROUP WITH MUSCULAR ATROPHY, LORDOSIS,
POSTURAL ALBUMINURIA

At an older age, in children from the fifth year
onwards, a second type of physical defect associated
with pronounced nervous disturbance presents
itself with some frequency. The body is thin and
badly nourished, and the muscular system especially
poorly developed and very lax in tone. The most
striking feature is the extreme lordosis, accompanied
usually by a secondary and compensatory curve
in the cervico-dorsal region, so that the shoulders
are rounded, with the head poked forward. Viewed
from in front the abdomen is seen to be prominent^
overhanging the symphysis pubis, while the
shoulders have receded far backwards. The
scapulae have been dragged apart, as though by the
weight of the dependent arms, with aversion of their
vertebral borders and lowering of the points of
the shoulders. The position which they adopt is that
into which the body falls when it ceases to be braced
by strong muscular support. The muscular system
is here so weakly developed and so toneless that the
posture is determined by the bony structure and its
ligamentous attachments.

The lordosis resembles the similar deformity
which develops in cases of primary myopathy,
when the spinal muscles have undergone complete
atrophy. As in myopathy the movements are

152 THE NERVOUS CHILD

very uncertain. The children are apt to fall heavily
when the centre of gravity is suddenly displaced,
because their upright posture is maintained by
balancing the trunk upon the support of the pelvis.
The frequency and severity of the falls which these
children suffer is a common complaint of the mother.
The faulty posture is often associated with slight
albuminuria. Its appearance is very capricious,
but it is dependent to a great extent upon the
assumption of the erect posture. There has been
much discussion as to its explanation. It has been
argued that the lordosis itself produces the albumin-
uria by mechanical compression of the renal vein,
and it is said that albuminuria can be produced,
even in the prone position, by placing the child in
a plaster jacket applied so as to maintain the
position of lordosis. Other observers, however,
have not obtained this result. It seems most
likely that the albuminuria is due to defective tone
in the vasomotor musculature, comparable in
every way to the defective tone in the muscles
of the skeleton. We have often further evidence
of vasomotor weakness. Fainting attacks are so
common as to be the rule rather than the exception.
Again, mothers are likely to complain of the child's
pallor and of dark lines under the eyes, especially
after exertion or in the reaction which follows
excitement of any sort. As a rule a blood count
will not show any very striking evidence of true
anaemia. The pallor is of vasomotor origin, de-
termined by faults in the distribution of the blood
from vasomotor weakness and not by deficient

NERVOUSNESS AND PHYSIQUE 153

blood formation. Circulatory and vasomotor dis-
turbance probably also accounts for the dyspeptic
pains and vomiting which commonly accompany
any emotional excitement, or follow any unusual
exertion or fatiguing experience. Constipation is
a common, and mucous diarrhoea an occasional,
symptom. The abdomen is often pigmented. The
hands and feet are usually cold and cyanosed.

The extreme nervousness of the children is the
point upon which most stress may be laid in the
present connection. The association of albuminuria
with neurosis in childhood has been noticed by
many observers. The gastric and intestinal
symptoms are especially characteristic. If the
condition of the children is not materially improved,
and if the symptoms, both of the physical defect
and of the nervous disturbance, are not cut short,
we may predict that in adult age their lives will
be made miserable by a variety of abdominal
symptoms dependent both on the vasomotor
disturbance and upon the accompanying neurosis.
Now that surgery forms so large a part of our
therapeutic proceedings, they may not reach middle
life without being submitted to one or more surgical
operations. With good management both on the
physical side and on the moral or psychological side
they can be made into strong and useful members
of society.

The treatment of these cases may be summed up
as follows :

(a) We must search for any source of infection,
a source which is often to be found in the condition

154 THE NERVOUS CHILD

of the tonsils. Enucleation may then be indicated
as the first step in treatment.

(6) Massage and gymnastic exercises calculated
to improve the muscular tone, while every effort
is made to secure for the child as perfect hygiene
in the environment as possible.

(c) The stimulating effect of cold douches is
often very evident in improving the vasomotor
tone. These children, however, will not stand well
the abstraction of heat from their thin and chilly
little bodies, so that it is a good plan before the
colder douche to immerse the child in a hot bath
and to return again to the bath momentarily
afterwards. With these precautions children will
often enjoy a cold spray, the temperature of which
may be constantly lowered as they become used to
it. Prolonged hot bathing has a correspondingly
prejudicial effect.

(d) We must be on the watch to prevent the
development of further postural deformities, such
as scoliosis. If a child of strong muscular tone
and good physique habitually adopts some posture,
curled up, it may be, in some favourite easy-chair,
there is little likelihood that its constant assumption
will produce deformity. When the muscular system
is lax and weak, on the other hand, deformity such
as scoliosis is very readily caused. It is important,
for example, to see that the child does not habitually
incline to one side in reading or writing. When
there is little energy for free and energetic play the
children are apt to become great bookworms. If
there is shortsightedness, the dangers are corre-

NERVOUSNESS AND PHYSIQUE 155

spondingly increased. A special chair may be made
with a well-fitting back and the seat a little tilted
upwards so as to throw the child's trunk on to
the support of the back. Lastly, a desk, the
height of which can be regulated at will, can
be swung into the proper position. The child,
sitting straight and square, with the weight sup-
ported by the foot-rest and back as well as by
the seat of the chair, should be taught to write
with an upright hand, avoiding the slope which
leads to sitting sideways with the left shoulder
lowered.

(e) Malt extract, cod liver oil, Parrish's food, and
other tonics may be of undoubted service.

(3) RHEUMATISM AND CHOREA

It is certain that there is a close association
between rheumatism in childhood and the common
nervous affection known as chorea. We are still
ignorant of the precise nature of the infection which
we know as rheumatism. There is much to suggest
that in rheumatism we have to deal only with a
further stage in those catarrhal infections to which
so much infantile ill-health is to be attributed, and
that endocarditis and arthritis, when they arise,
signalise the entry of these catarrhal, non-pyogenic
organisms into the blood stream, overcoming at last
the barrier of lymphoid tissue which has hyper-
trophied to oppose their passage. Certainly the
connection of rheumatism with catarrhal infections
of the mucous membranes and adenoid enlargements

156 THE NERVOUS CHILD

of all sorts is a close one. Whatever its nature,
the rheumatic infection in childhood is more lasting
and chronic than in adult life. Rheumatism in
childhood is not manifested by acute and short-
lived attacks of great severity so much as by
a long-continued succession of symptoms of a
subacute nature, a transient arthritis, perhaps,
succeeding an attack of sore throat with torticollis,
to be followed by carditis, to be followed again
by another attack of tonsillitis. And so the cycle
of symptoms revolves. In most cases the child
grows thin and weak; in most cases he becomes
restless, irritable, and unhappy ; often there is
definite chorea. Of this cerebral irritability chorea
is the expression. In adults, chorea is perhaps
more obviously associated with mental stress
of all sorts and with states of excitement and
agitation. In the case of little children it is
often only the mother who really appreciates how
radical an alteration the child's whole nature
has undergone, and how great the element of
nervous overstrain has been before the chorea has
appeared.

Of the treatment of chorea there is no need to
speak. It is purely symptomatic. Isolation, best
perhaps away from home, as might be expected,
gives the best results. If there are pronounced
rheumatic symptoms, the salicylates will be needed ;
if there is anaemia, arsenic and iron ; if there is sleep-
lessness and great restlessness, bromides or chloral.
Hypnotism is often almost instantly successful,
but, apart from hypnosis, curative suggestions

NERVOUSNESS AND PHYSIQUE 15?

proceeding from the attendants form the principal
means at our disposal.

(4) EXHAUSTION AND KATATONIA

A large number of children, in convalescence
from infective disorders, when the nutrition of the
body has fallen to a low ebb, show as evidence
of cerebral exhaustion a group of symptoms which
in a sense are the reverse of those which characterise
cerebral irritation and chorea. The healthy child
is a creature of free movement. The children we
are now considering will sit for a long time motion-
less. The expression of their faces is fixed, immobile,
and melancholy. If the arm or leg is raised it will
be held thus outstretched without any attempt
to restore it to a more natural position of rest for
minutes at a time. The posture and expression
remind us at once of the katatonia which is sympto-
matic of dementia praecox and other stuporose and
melancholiac conditions in adult life. Symptoms
of this sort are especially common in children with
intestinal and alimentary disturbances of great
chronicity.

The symptom is so frequently met with that it is
strange that it should have attracted so little atten-
tion as compared with the contrasting condition of
chorea. And yet it is of more serious significance,
more difficult to overcome, and with a greater danger
that permanent symptoms of neurasthenia will
result. In early childhood a careful dietetic regime,
suitable hygienic surroundings, and a stimulating

158 THE NERVOUS CHILD

psychical atmosphere will often effect great im-
provement. As in chorea, however, relapses are
frequent, and there are cases which for some un-
explained reason are peculiarly resistant to all
remedial influences.

(5) HYSTERIA

In hysteria, in contrast to the types previously
described, the infective element may be completely
absent. Except in some special features of minor
importance the symptoms of hysteria do not differ
from those of adults, and, as in adult age, the con-
dition of hysteria may be present although the
physical development may be perfect. We cannot
here speak of any physical characteristics which are
associated with the nervous symptoms.

The third or fourth year represents the age
limit, below which hysterical symptoms do not
appear. Thereafter they may be occasionally met
with, with increasing frequency. At first, in
the earlier years of childhood, there is no pre-
ponderance in the female sex. As puberty
approaches, girls suffer more than boys.

It may be said to be characteristic of hysteria
in childhood that its symptoms are less complex
and varied than in adult life. The naive imagina-
tion of the child is content with some single symptom,
and is less apt to meet the physician half-way
when he looks for the so-called stigmata. Similarly
mono - symptomatic hysteria is characteristic of
oases occurring in the uneducated or peasant class.

NERVOUSNESS AND PHYSIQUE 159

In children, hysterical pain, hysterical contractures
or palsies, mutism, and aphonia are the most usual
symptoms. Hysterical deafness, blindness, and
dysphagia are manifestations of great rarity in
childhood.

CHAPTER XII
THE;NERVOUS CHILD IN SICKNESS

Ftime of sickness the management of the
nervous child becomes very difficult. Rest-
lessness and opposition may reach such a pitch
that it may be almost impossible to confine the
patient to bed or to carry out the simplest treat-
ment. Sometimes days may elapse before the sick-
nurse who is installed to take the place of the
child's usual attendant is able to approach the
cot or do any service to the child without pro-
voking a paroxysm of screaming. In such a case
any systematic examination is often out of the
question, with the result that the diagnosis may
be delayed or rendered impossible. There is only
one reassuring feature of a situation, which arises
only in nurseries in which the management of the
children is at fault ; the doctor has learned from
experience that this pronounced opposition of the
child to himself, to the nurse, and even to the
mother, is of itself a reassuring sign, indicating,
as a rule, that the condition is not one of grave
danger or extreme severity. When the child is
more seriously ill, opposition almost always dis-
appears, and the child lies before us limp and

THE NERVOUS CHILD IN SICKNESS 161

passive. Only with approaching recovery or con-
valescence does his spirit return and renewed
opposition show itself.

Extreme nervousness in childhood carries with
it a certain liability towards what is known as
" delicacy of constitution." The sensitiveness of
the children is so great that they react with striking
symptoms to disturbances so trivial that they
would hardly incommode the child of more stable
nervous constitution. For example, a simple cold
in the head, or a sore throat, may cause a con-
vulsion or a condition of nervous irritability which
may even arouse the suspicion that meningitis is
present. Or, again, a little pharyngeal irritation
which would ordinarily be incapable of disturbing
sleep may be sufficient to keep the child wide
awake all night with persistent and violent coughing.
The little irritating papules of nettlerash from which
many children suffer are commonly disregarded by
busy, happy children during the day, and even
at night hardly suffice to cause disturbance. The
nervous child, on the other hand, will scratch
them again and again till they bleed, tearing at
them with his nails, and making deep and painful
sores.

The temperature is commonly unstable and
readily elevated. Moreover, feverishness from
whatever cause is often accompanied by an active
delirium, which is apt to occasion unnecessary
alarm. This symptom of delirium is always a
manifestation of an excitable temperament. I
remember being called to see a young woman who
ii

162 THE NERVOUS CHILD

was thought to be suffering from acute mania.
Examination showed that she was suffering from
pneumonia in the early stages. It was only later
that we discovered that she had always been of an
unstable nervous temperament, and had been in
an asylum some years before. Those of us who
are fortunate in possessing a placid temperament
and have developed a high degree of self-control
are not likely to show delirium as a prominent
symptom should we fall ill with fever ; just as we
should not struggle and scream too violently when
we " come round " from having gas at the dentist's.
Looked at from this point of view, it is natural for
all children to become delirious readily, and this
tendency is peculiarly marked in those who are
unduly nervous.

As a consequence of this extreme sensitiveness,
the nervous child is likely to suffer more than
others from a succession of comparatively trifling
ailments and disturbances. The delicacy of the
child has, in this sense, a real existence, and is not
confined to the imagination of over-anxious and
apprehensive parents. No doubt the nervous
mother of an only child does worry unnecessarily,
and is far too prone to feed her fears by the daily
use of the thermometer or the weighing-machine ;
but her friends who are happy in the possession of
numerous and placid children are not justified in
laying the whole blame upon her too great solicitude.
Children who are members of large families, whose
nervous systems have been strengthened by contact
with their brothers and sisters, are not habitually

THE NERVOUS CHILD IN SICKNESS 163

upset by trifles, and suffer even serious illnesses
with symptoms of less severity. Nervous children,
and only children, on the other hand, show the
opposite extreme. Nevertheless, the mother of a
nervous and delicate child — a child, that is to say»
who, even if he is not permanently an invalid,
nevertheless never seems quite well and lacks the
robustness of other children — should realise clearly
how much of this sensitiveness is due to the
atmosphere of unrest and too great solicitude
which surrounds him. It is a matter of universal
experience that excess of care for only children
has a depressing influence which affects their
character, their physical constitution, and their
entire vitality. At all costs we must hide our own
anxieties from the child, and we must treat his
illnesses in as matter-of-fact a way as possible.

When illness comes, his daily routine should be
interrupted as little as possible. In dealing with
nervous children, it is often better to lay aside
treatment altogether rather than to carry out a
variety of therapeutic procedures which have the
effect of concentrating the child's mind upon his
symptoms. When we grown-up people are sick,
we often find a great deal of comfort in submitting
ourselves to some form of treatment. We have
great faith, we say, in this remedy or in that. It is
our remedy, a nostrum. The physician knows well
that the opportunities which are presented to him
of intervening effectually to cut short the processes
of disease by the use of specific cures are not very
numerous, and that often enough the justification

164 THE NERVOUS CHILD

for his prescription is the soothing effect which it
may exercise upon the mind of the patient, who,
believing either in the physician or in his remedy,
finds confidence and patience till recovery ensues.
As a rule this form of consolation is denied to little
children. They have no belief in the efficacy of
the remedies which are applied with such vigour
and persistence. Indeed, it is not the child, but
his anxious mother, who finds comfort in the thought
that everything possible has been done. There-
fore, a prescription must be written and changed
almost daily, the child's chest must be anointed
with oil, and the air of the sick-room made heavy
with some aromatic substance for inhalation, and
all this when the disturbance is of itself unim-
portant, and owes its severity only to the undue
sensitiveness of the child's nervous system.

The very name of illness should be banished from
such nurseries. Everything should be done to re-
assure the child and to make light of his symptoms,
and we can keep the most scrupulous watch over
his health without allowing him to perceive at all
that our eye is on him. With older children the
evil results of suggestions, unconsciously conveyed
to them by the apprehension of their parents,
become very obvious. The visit of the doctor, to
whom in the child's hearing all the symptoms
are related, is often followed by an aggravation
which is apt to be attributed to his well-meant
prescription. The harm done by examinations,
which are specially calculated to appeal to the
child's imagination, as, for instance, an X-ray ex-

THE NERVOUS CHILD IN SICKNESS 165

amination, is often clearly apparent. I remember
a schoolboy of thirteen who was sent to me because
he had constantly complained of severe abdominal
pain. He was a nervous child with a habit spasm,
the son of a highly neurotic father and an over-
anxious mother. An X-ray examination was made,
but showed nothing amiss. The child's interest and
preoccupation in the examination was painfully
obvious. That night his restraint broke down
altogether, and he screamed with pain, declaring
that it had become insupportable. Younger children,
less imaginative but equally perverse, noticing
how anxiously their mothers view their symptoms,
will often make complaint merely to attract atten-
tion and to excite expressions of pity or condolence.
Sometimes they will enforce their will by an appeal
to their symptoms. I have had a little patient of
no more than thirteen months of age who suffered
severely and for a long time from eczema, and
who in this way used his affliction to ensure that he
got his own way. If he was not given what he
wanted immediately he would fall to scratching,
with an expression upon his face which could not
be mistaken. To him, poor child, the grown-up
people around seemed possessed of but one desire —
to stop his scratching ; and he had learnt that if
he showed himself determined to scratch they
would give way on every other point.

The ill-effects of departing too readily from
ordinary nursery routine on account of a little
illness, and of adopting straightway a variety of
measures of treatment, is well shown in cases of

166 THE NERVOUS CHILD

asthma in children. The asthmatic child is almost
always of a highly nervous temperament, and
often passionate and ungovernable. Often the
most effective treatment of an attack, which usually
comes on some hours after going to bed, is to make
little of it, to talk naturally and calmly to the child,
to turn on the light, and to allow him, if he will,
to busy himself with toys or books. To be seized
with panic, to send post-haste for the doctor, to
carry the patient to the open window, to burn
strong-smelling vapours, and so forth, not only is
apt to prolong the nervous spasm on this occasion,
but makes it likely that a strong impression will be
left in his mind which by auto-suggestion will
provoke another attack shortly. With nervous
children a seeming neglect is the best treatment of
all trivial disorders. Meanwhile we can redouble
our efforts to remedy defects in management, and
to obtain an environment which will gradually
lower the heightened nervous irritability.

When the illness is of a more serious nature, as
has been said, the restlessness as a rule promptly
disappears. In each case it must be decided whether
it is best for the child to be nursed by his mother
and his own nurse, or by a sick-nurse. In the
latter event the ordinary nurse and the mother
should absent themselves from the sick-room as
much as possible. Often the firm routine of the
hospital nurse is all that is wanted to obtain rest.
Less often, the child will be quiet with his own
nurse, and quite unmanageable with a stranger.

There is, however, another side to the question*

THE NERVOUS CHILD IN SICKNESS 167

The relation of neurosis in childhood to infection^
of the body is complex. I have said that with the
nervous child a trivial infection may produce
symptoms disproportionately severe. Persistent
and serious infection, however, is capable of pro-
ducing nervous symptoms even in children who (WE
were not before nervous, and we must recognise
that prolonged infection makes a favourable soil
for neuroses of all sorts. The frequency with which
St. Vitus's dance accompanies rheumatism in child-
hood forms a good example of this tendency. The
child who, from time to time, complains of the
transient joint pains which are called " growing
pains," and who is found by the doctor to be suffer-
ing from subacute rheumatism, is commonly restless,
fretful, and nervous. Appetite, memory, and the
power of sustained attention become impaired.
Often there is excessive emotional display, with,
perhaps, unexplained bursts of weeping. The
child is readily frightened, and when sooner or
later the restless, jerky movements of St. Vitus's
dance appear; the usual explanation is that some
shock has been experienced, that the child has seen
a street accident, has been alarmed by a big dog
jumping on her, or by a man who followed her —
shocks which would have been incapable of causing
disturbance, and which would have passed almost
unappreciated had not the soil been prepared by
the persistent rheumatic infection.

The management of the nervous child whose
physical health remains comparatively good is
difficult enough, but these difficulties are increased

168 THE NERVOUS CHILD

many times when the physical health seriously
fails. To steer a steady course which shall avoid
neglecting what is dangerous if neglected, and over-
emphasising what is dangerous if over-emphasised,
calls for a great deal of wisdom on the part both of
the mother and her doctor.

CHAPTER XIII

NERVOUS CHILDREN AND EDUCATION ON
SEXUAL MATTERS

IN this chapter I approach with diffidence a sub-
ject which is rightly enough occupying a great
deal of attention at the present time : the instruc-
tion of our children in the nature, meaning, and
purpose of sexual processes. It is a subject filled
with difficulties. Every parent would wish to
avoid offending the sense of modesty which is the
possession of every well-trained child, and finds it
difficult to escape the feeling that discussion on
such matters may do more harm than good. There
is certainly some risk at the present time that, put-
ting reticence on one side, we may be carried too far
in the opposite direction. The evils which result
from keeping children in ignorance are well appre-
ciated. We have yet to determine the effect upon
them of the very frank and free exposure of the
subject which is recommended by many modern
writers. Nevertheless, it must be granted that it
is not right to allow the boy or girl to approach
adolescence without some knowledge of sex and the
processes of reproduction. If nothing is said on such

subjects, which in the nature of things are bound

169

170 THE NERVOUS CHILD

to excite a lively interest and curiosity in the minds
of older children, evil results are apt to follow.
Because parents have never mentioned these sub-
jects to their child, they must not conclude that
he is ignorant of all knowledge concerning them.
It is not unlikely that the question has often occu-
pied his thoughts, and that his speculations have
led him to conclusions which are, on the whole, true,
although perhaps incorrect in matters of detail.
Most children, unable to ask their mother or father
direct questions upon matters which they feel in-
stinctively are taboo, have pieced together, from
their reading and observation, a faulty theory of
sexual life. The pursuit of such knowledge, in
secret, is not a healthy occupation for the child.
His parents' silence has given him the feeling that
the unexplored land is forbidden ground. In
satisfying his curiosity he is most certainly fulfilling
an uncontrollable impulse, but he has been forced
to be secretive, and to look upon the information
he has acquired as a guilty secret. So far even the
best of children will go upon, the dangerous path.
If training has been good, and if the child has re-
sponded well to it, he will go no further. Though
he can hardly be expected to refrain from con-
structing theories and from testing them in the light
of any chance information which may come his
way, he will instinctively feel that the subject is one
best left alone. He will not talk of it with other
boys — not even with those who are older than
himself and whose superior knowledge in all other
matters he is accustomed to respect.

EDUCATION ON SEXUAL MATTERS 171

We need not be surprised, however, that the
majority of children do not attain to this high
standard of conduct, and that the interest and
excitement of exploring the unknown and the for-
bidden proves too great. Children will consult
with each other about such matters, and knowledge
of evil may spread rapidly from the older to the
younger. In some schools, as is well known, there
may grow up with deplorable facility an unhealthy
interest in sexual matters. On the surface of
school life all may seem fair enough, but beneath,
hidden from all recognised authority, lies much that
is unspeakable. If the boy has not been taught
to have clean thoughts upon matters which are
essentially clean, if he has not learned to know evil
that he may avoid it, he may not escape great
harm. The fault in us which kept him in
ignorance will recoil upon our own heads. He
will maintain the barrier which was erected in
the first place by our own unhappy reticence,
and we may find it a hard task to penetrate
behind it and prevent his constant return to
secret thoughts and imaginings or secret habits and
practices. Certain physiological processes come
to have for him an unclean flavour which is yet
perniciously attractive. He knows little of the
real meaning of sexual processes or of the great
purpose for which they are designed. It is only
that an unhealthy interest becomes attached to all
subjects which are scrupulously avoided in general
conversation. In secret he develops a wrong
attitude to all these matters.

172 THE NERVOUS CHILD

Oliver Wendell Holmes l tells us that in religion
certain words and ideas become " polarised," that
is to say, charged with forces of powerful suggestion,
and must be " depolarised."

" I don't know what you mean by ' depolarising '
an idea, said the divinity-student.

" I will tell you, I said. When a given symbol
which represents a thought has lain for a certain
length of time in the mind, it undergoes a change
like that which rest in a certain position gives to
iron. It becomes magnetic in its relations — it is
traversed by strange forces which did not belong
to it. The word, and consequently the idea it re-
presents, is polarised.

" The religious currency of mankind, in thought,
in speech, and in print, consists entirely of polarised
words. Borrow one of these from another language
and religion, and you will find it leaves all its
magnetism behind it. Take that famous word, O'm,
of the Hindoo mythology. Even a priest cannot
pronounce it without sin ; and a holy Pundit would
shut his ears and ran away from you in horror, if
you should say it aloud. What do you care for
O'm ? If you wanted to get the Pundit to look at
his religion fairly, you must first depolarise this
and all similar words for him. The argument for
and against new translations of the Bible really
turns on this. Scepticism is afraid to trust its
truths in depolarised words, and so cries out against
a new translation. I think, myself, if every idea

1 The Professor at the Breakfast Table, Oliver Wendell Holmes.

EDUCATION ON SEXUAL MATTERS 173

our Book contains could be shelled out of its old
symbol and put into a new, clean, unmagnetic
word, we should have some chance of reading it as
philosophers, or wisdom-lovers, ought to read it —
which we do not and cannot now, any more than
a Hindoo can read the ' Gayatri ' as a fair man and
lover of truth should do."

Now in the minds of many boys and some girls
certain words and ideas connected with certain
physiological processes become polarised. It is
the parents' duty to depolarise them. It is a task
which cannot well be deputed to others ; nor can
much help be derived from books, though many
have been written with the object of initiating
children into the mysteries of sex. No one but a
parent is likely to be on sufficiently intimate terms
with the child to enable the subject to be approached
without restraint or awkwardness, and no book can
adapt itself to the varying needs of individual
children. An exposition in cold print, or a single
formal lecture on the subject, is apt to do more harm
than good. I have seen instructions to parents to
deliver themselves of set speeches, examples of
which are given, which seem to me well calculated
to repel and frighten the nervous child. Still more
dangerous is the advice to make sexual hygiene a
subject for class study. The task requires that
parents should be upon very intimate terms with
their children, and on suitable occasions, when this
feeling of intimacy is strong, children should be
encouraged to speak freely and to ask for explana-

174 THE NERVOUS CHILD

tions. By a judicious use of such opportunities
piece by piece the whole may be unfolded. In
order that the child may approach the subject in the
proper spirit we may stimulate interest by a few
lessons in Natural History. A child of eight or ten
years of age is not too young to learn a little of the
outlines of anatomy and physiology. If he is told
a few bald facts about the skeleton, about the
circulation and the processes of digestion such as any
parent can teach at the cost of a few hours' study of
a handbook, this will lead naturally enough, in later
lessons, to a similar talk upon the excretory organs,
reproduction, and the anatomy and processes of sex,
suitable to the individual. To achieve " depolarisa-
tion," there is nothing more efficacious than the
frankness and explicitness of scientific statement,
however elementary. Later a little knowledge of
Botany and Zoology will enable a parent to sketch
briefly the outlines of fertilisation and reproduction.
The child may grasp the conception that the life
of all individual plants and animals is directed
towards the single aim of continuing the species.
He can be told how the bee carries the male pollen
to the female flower, how all living things habitually
conjugate, the lowest in the scale of development
as well as the highest, and how the fertilised egg
becomes the embryo which is hatched by the
mother or born of her. As the child grows older
and understands more and more of these natural
processes an opportunity can be used to make the
presentation of the subject more personal. He
can be told that during childhood his own sexual

EDUCATION ON SEXUAL MATTERS 175

processes have been undeveloped, but that as he
grows older they will awake. That with their
awakening in adolescence new temptations to self-
indulgence in thought or action may assail him, but
that these temptations are delayed by the wisdom
of Nature until his understanding has grown and his
man's strength of character has developed. A high
ideal of purity should be set before boy and girl
alike, and the conception of sex from the beginning
should be associated in their minds with the high
purpose to which some day it may be put. Before
the boy goes to a boarding-school he should have
imbibed from his father the desire for moral cleanli-
ness, the knowledge of good and of evil, and a cordial
dislike for everything that is sensual, self-indulgent,
or nasty. Talks on such subjects should be very
infrequent, but I believe that, if " depolarisation " is
to be achieved, they must be repeated every now
and then during later childhood and in adolescence.
To attempt to impart all this interesting information
in a single constrained and awkward interview is to
court failure, or at least to run the risk that the
explanation is not fully understood, so that the
child is mystified, or even offended in his sense of
propriety.

I have dwelt at some length upon this question of
sex education, because it is one of especial difficulty
when we have to deal with a child of nervous in-
heritance, or with a child in whom symptoms of
neurosis have developed in a faulty home environ-
ment. Misconduct in sexual matters is a sign of /
deficient nervous and moral control, and when the

176 THE NERVOUS CHILD

conduct in other respects is ill-regulated, the de-
velopment of sexual processes must be watched with
some anxiety. There are those who see a still
more intimate relationship between errors of conduct
or symptoms of neurosis in childhood and the sexual
instincts.

It is perhaps necessary here briefly to refer to the
teaching of Sigmund Freud of Vienna, because his
views have attracted a great deal of attention in this
country and have become familiar to a great part of
the reading public. Freud believes that the origin
of many abnormal mental states and of the disturb-
ances of conduct which are dependent upon them
is to be traced back to forgotten experiences, the
recollection of which has faded from the conscious
mind, but which are still capable of exerting an
indirect influence. He regards the process of for-
getting, not as merely a passive fading of mental
impressions, but as an active process of repression,
by which the experience, and especially the un-
pleasant experience, is thrust and kept out of con-
sciousness. There thus arises a mental conflict
between the forces of repression and the forces which
tend to obtrude the recollection into consciousness,
and at times the energy engendered in this conflict
escapes from the censorship of the repressing forces
and finds vent in the production of abnormal mental
states or disorders of conduct. Thus to take a
simple example, a business man who has had a trying
day at the office, on returning home in the evening
may succeed in thrusting out of his consciousness
the thought of his disappointments and worries,

EDUCATION ON SEXUAL MATTERS 177

yet the disturbance in his mind may show itself
in quarrels with his wife or complaints of the quality
of the cooking at dinner.

Freud has called attention to the part which
the suppressed and long-forgotten experiences of
early childhood play in the production of neuroses
of all sorts at a later date, and he has laid especial
emphasis on sexual experiences as peculiarly fruit-
ful causes of such disturbances. Those who have
embraced Freud's teaching have gone even farther
than he in this direction, and by psycho-analysis—
that is to say, by attempting in intimate conversa-
tion to arouse the dormant memory and lay bare the
buried complex, the suppression of which has pro-
duced the conflict in the mind of the sufferer — will
seldom fail to discover the influence of sexual forces
and sexual attractions which, while capable of
causing disorders of mind and of conduct, show them-
selves only obscurely and indirectly, as, for example,
in dreams or in symbolic form.

So far as the nervous disorders of children are con-
cerned, much that is written to-day upon the influence
of repressed sexual experiences may be dismissed as
grotesque and untrue. The conclusions to which the
psycho-analyst is habitually led, and which he puts
forward with such confidence, can be convincing only
to those who have replaced the study of childhood by
the study of the writings of Freud and his school.
Thus it is common enough to find a mother com-
plaining that her child of two or three years of age
is bitterly jealous of the new baby who has come to
share with him his mother's love and attention.

12

178 THE NERVOUS CHILD

According to the views of Freud, we are to recognise
in this jealousy an exhibition of the sexual instincts
of the older child, who scents a possible rival for the
affections of his mother. Even if we give to the
term sexual the widest possible meaning, it is difficult
for a close observer of children to detect any truth
in this conclusion. The behaviour of the older
child to the newly born will be determined mainly
by the attitude adopted by the grown-up persons
around him and by the unconscious suggestions
which his impressionable mind receives from them.
If the mother is fearful of what may happen, and
refuses to leave the children alone, she will find it
hard to hide from the older child her conviction that
danger is to be apprehended from him. If this
suggestion acts upon his mind, and if the reputation
that he is jealous of the new baby becomes attached
to him, he will assuredly not fail to act up to it,
and her daily conduct will appear to prove the
justness of his mother's apprehension. Fortunately,
mothers are commonly able to divest themselves of
such fears as these. The older child is brought
freely to the baby to admire him, to bestow caresses
on him, and to speak to him in the very tones of
his elders. In a few days his reputation is estab-
lished, that he is " so fond of the baby," and to
this reputation too he faithfully conforms. We have
seen in an earlier chapter that constantly and os-
tentatiously to oppose a child's will is to produce a
counter-opposition which because of its persistence
and vigour appears to have behind it the strongest
possible concentration of mind and power of will.

EDUCATION ON SEXUAL MATTERS 179

Yet if we cease to oppose, the counter-opposition
which appeared so formidable at once dissolves,
and the difficulty is at an end. We took as an
example the child's apparent determination to
approach as near as possible to the fire, the one
place in the room which our fear of accident forbids
him. The difficulty with the new baby is but an-
other example of the same tendency. If he does not
know that the ground is forbidden, if we do not
concentrate his attention on the prohibition, he
will show no particular desire to approach it. His
apparent jealousy of his little brother is the result
not of the rivalry of sex, but of bad management.

Again, it is occasionally a subject of complaint
that children will apparently dislike their father,
that they will shrink from him or burst into tears
whenever he approaches them. There is no need
to see in this the child's jealousy of the father as
a rival in the affections of his mother, which is
the explanation proffered by the school of Freud.
Every action and every occupation of the child
during the whole day can be made a pleasure or
a pain to him, according to the attitude of his
nurse and mother towards it. Eating and drinking
should be pleasant and are normally pleasant.
The same forces which are sufficient to make every
meal-time a signal for struggling and tears, are
sufficient to produce this dislike, apparently so
invincible, to the father of his being.

Although the nervous troubles of infancy are not
commonly due, as Freud and his numerous followers
would have us believe, to suppressed sexual desires

180 THE NERVOUS CHILD

or experiences, it is clear that in the sensitive
mind of the child the reception of a severe shock
may have effects long after the memory of it
has disappeared from consciousness. In a medical
journal there was recently recounted the case of
an officer of the R.A.M.C. who all his life had
suffered from claustrophobia — the fear of being
shut up in a closed space. By skilful questioning,
the remembrance of a terrifying incident in his
childhood was regained. As a child of five he
had been shut in a passage in a strange house by the
accidental banging to of a door, unable to escape
from the attentions of a growling dog. A complete
cure was said to follow upon the discovery that in
this incident lay the origin of the phobia. Never-
theless, observation would lead me to lay the greater
stress not upon any one particular shocking or
terrifying experience, but upon the attitude of
parents and nurses in focusing the child's attention
upon the danger, and in sapping his confidence by
showing their own apprehensions and communi-
cating them to him.

As a method of treatment for neuroses of child-
hood, psycho-analysis is not only unsuccessful,
it has dangers and produces ill effects which far
outweigh any advantage which may be gained
from it.

There can be no doubt that Freud has exaggerated
the part which sexual impulses play in causing
neurosis. It will be sufficient for us to recognise
that for the nervous child the sexual life has especial
dangers, and we should redouble our efforts to

EDUCATION ON SEXUAL MATTERS 181

prevent his ideas on the subject becoming " polar-
ised." For the child whose environment has been
well regulated and who has developed strength o£
character, self-control, and self-respect, there need
be no fear.

CHAPTER XIV
THE NERVOUS CHILD AND SCHOOL

AT the onset of puberty childhood comes to
an end, and the period of adolescence
begins. Into these further stages of development
it is not proposed to enter, but it may be well to
consider a question which is apt to present itself
for answer at this period : " Should the boy, or girl,
of nervous temperament, or whose development up
to this point has been accompanied by symptoms
of nervous disorder, be sent to a boarding-school ? "
So long as the child remains at home the home
environment is the force which alone is concerned
in moulding his character. We have seen how
plastic the young child is, how imitative, how
suggestible, how prone to form habits good or bad.
The diversity of type shown by the homes is re-
flected in the diversity of character and conduct
exhibited by the children. The home is the culture
medium, and in no two homes is its composition the
same. For each child home influence remains to
a great extent unchanged, and in great part un-
changeable. Its action upon the child is constant
and long sustained. Hence, it is not surprising

that the growth of his character and2powers is

ill

THE NERVOUS CHILD AND SCHOOL 183

commonly unequal. At one point we may find a
good crop of virtues, at another a barren tract ;
and the home influences which have ripened the
one and blighted the other are calculated by the
lapse of time to increase the contrast rather than
to diminish it.

I suppose it is for this reason that the custom of
sending children to boarding-schools has so firm a
hold among us. The boarding-school forms an
environment selected to correct the inequalities
which result from the special action upon the child
of individual homes. The life of a boy in one of
our large public schools is well calculated to act as
a corrective in this way not only by reason of its
ordered routine and discipline, but still more because
it is affected, perhaps for the first time, by the
strong force of public opinion. It is the strength
of this public opinion which gives to our public
schools their peculiar character and produces their
peculiar effects. That which the schoolboy most
despises is what he calls " Bad Form," and he bows
down and worships an idol he himself has set up,
the name of which is " Good Form." Public opinion
forms the code of morals observed in the school.
The standard set is commonly not so high as to be
very difficult of attainment. It demands many good
qualities. To lie, to sneak, to tell tales, to bully,
to " put on side," are bad form. In some respects
the definition of what is virtuous may be a little
hazy. Thus it may be wrong to cheat to gain a
prize, but to copy from one's neighbour only so much
as will enable one to pass muster and escape con-

184 THE NERVOUS CHILD

demnation is no great sin. In short, good form
demands that a boy should have all the social
virtues : that he should be a good fellow, easy to
live with, and possessed of a high sense of public
spirit — good qualities certainly, though perhaps not
those which help to make the reformers or martyrs
of this world.

The school life is the life of the herd, and to be
successful in it the boy must mingle with the herd,
not break from it or shun it. Good form — if we
came to analyse the conception that underlies it —
consists only in a close approximation to the standard
pattern ; bad form, in any deviation from it. It is
this similarity of type and community of ideals
which makes it so easy for most public-school boys
to get on well with one another. When in after
life they are thrown among a set of men who know
nothing of their conception of good form, and whose
training has been on completely different lines, there
may be a corresponding difficulty.

Now what is true of public-school life is of course
also true of the larger life after schooldays are over
for which all education is a preparation. These
qualities of sociability and good sportsmanship
will stand a man in good stead throughout life.
Even the most ardent and active spirit will benefit by
being subjected for some years to this steady pressure
of public opinion. The most part will learn from
it good sense, consideration for others, and self-
control. As they pass from the lower forms to the
higher in the school they will learn too to support
authority without doing injustice, and to bring the

THE NERVOUS CHILD AND SCHOOL 185

weight of public opinion to bear upon others. And
to all this training many a man owes his happiness
in after life — a happiness which he could not have
secured if his character had been moulded only by
the environment of his home, or by the home in
combination with the less-powerful corrective of
a day school. For the nervous child the passage
from home to school life may involve considerable
mental strain. He may be morbidly self-conscious
and timid, or, unknown to himself — because he
has as yet no power of self-analysis and has no
opportunities of comparing himself with others —
he may have developed certain eccentricities. In
most cases the plunge into school life will be taken
well enough ; in a few the little vessel will not right
itself, and proves permanently unseaworthy. No
doubt as a rule a private school will have preceded
the public school, and this gradation should make the
entrance to the public school a lesser ordeal. But
it often happens that it is just in the case of the
nervous child that this intermediate stage has been
omitted, and that his thirteenth birthday finds him
still in the home circle.

If the boy's father has first-hand knowledge of life
in the lower forms of public schools, his experience
may enable him to form some estimate of the
effect of school life upon the nervous system of his
son. It is when parents or guardians have no such
experience of their own to guide them that mis-
takes are most liable to be made. I can myself
remember the unhappy state of some solitary and
eccentric schoolfellows of mine who aroused the

186 THE NERVOUS CHILD

resentment of " the Herd " by their behaviour or
opinions. If it is clear that the boy has a peculiar
temperament and is likely to suffer in this way,
some via media must be found. The home has
failed so that he must leave home and come under
the influence of some one who understands the
nature of the difficulty and can adapt the boy to
school life. A change of environment of this sort
as a preliminary to the public school is often all
that is needed. If his age permits, every effort
should be made in this way to obtain for the nervous
child who has developed peculiarities or faults the
benefits of a public-school education.

Some types of nervous children will show im-
mediate improvement when they go to school.
The boy who is passionate and disobedient, and
whose parents cannot control him, is best at school.
Boys who, from being much with grown-up people,
have become too precocious and have acquired
the habits and tastes of their elders, will dislike
school at first, but it will do them good. Their
fault shows that they are quick to learn and sensitive
to the influences of others, and they will soon
adapt themselves to their new surroundings. Boys
who are dreamy and imaginative, who early adopt
a " specialist " attitude towards life, who, however
ignorant they may be of everything else, cultivate
a reputation for omniscience in some particular
subject, such as Egyptology, astronomy, or the
construction of battleships, are usually nervous
boys whose symptoms will disappear at school.
Where undue timidity, phobia, or habit spasm is

THE NERVOUS CHILD AND SCHOOL 187

present, the question is more difficult to decide.
Every individual case must be studied as a whole,
and our object should be not unnecessarily to
deprive the boy of the wholesome training of public-
school life.

There are parents who from sheer ignorance add
to the difficulties which the boy encounters in
going to school. Failure to appreciate very small
points may cause unnecessary suffering. To be
the only boy in the school to wear combinations
is not a distinction that any new boy craves, how-
ever strong his nerves may be. A friend of mine
still relates with feeling how, twenty years ago,
he arrived at school with shirts which buttoned at
the neck ! At night when every one else in the
dormitory was asleep he sat for hours on his bed,
miserable beyond words, removing the buttons
and doing his best in the dark to bore buttonholes
which would admit what every other boy in the
school had — a collar stud.

With girls perhaps this question of fitness for
school life does not arise in so urgent a way. Girls
are usually older when they go to school, and girls'
schools are perhaps less terrifying and more like
home. There is, however, one important point
which should be borne in mind. The date of the
onset of puberty varies much in both sexes. If
the boy grows to a great hulking fellow at fourteen,
and even displays a desire secretly to borrow his
father's razor, he is at no particular disadvantage
as compared with his fellows. He is so much
bigger and stronger than the others that he may

188 THE NERVOUS CHILD

thereby early enjoy the distinction of playing at
"big side," or of getting a place in the school
Eleven. He is probably much envied by those of
the same age who, with the aid of their youthful
aspect, can still occasionally extract compensation
by inducing the railway company to let them
travel to school at half fare. But with girls it is
different. Many at fourteen or fifteen are children
still ; some are grown up, with the tastes, feelings,
and attraction of maturity. Those who have
developed fastest are often, for that very reason,
kept backward in school learning. Often they are
nervously the least stable. Now that large schools
for girls on the model of our public schools are
become the fashion, such precociously developed
and nervously unstable girls are apt to find them-
selves in the very uncongenial society of little girls
of twelve or thirteen. The elder girls commonly
hold aloof, while mistresses are apt to view this
precocious development with disapproval, and to
attempt to retard what cannot be retarded by
insisting that the young woman has remained a
child. I remember being called in consultation by
a surgeon who had been asked to operate for
appendicitis upon a girl of fourteen. I found a
tall, well-grown girl, with an appearance and manner
that made her look four years older. I could find
no signs of appendicitis, but I learned from her
that she had been for three months at a large girls'
school, and that in a few days' time her second
term was due to begin. As we became friends, she
agreed that her appendicitis and her resolve not

THE NERVOUS CHILD AND SCHOOL

to return to school, where she was unhappy, were
but different ways of saying the same thing. She
was an only child who had travelled a great deal
with her parents, had found her interests in their
pursuits, and had grown backward in school work.
The little girls with whom she was expected to
associate seemed to her mere children. The elder
girls did not want her friendship, and snubbed
her. I prescribed a change to a small boarding-
school with only a few girls, where age differences
would not matter so much, and where she could
make friends with girls older than herself, though
not more mature.

Into their school life we need not follow the
children. Happily the time is past when school-
masters and schoolmistresses were incapable of
understanding their charges, and confounded ner-
vous exhaustion with stupidity or timidity with
incapacity.

And so we come back to the point from which
we started :

The nervous infant, restless, wriggling, and
constantly crying ! The nervous child, unstable,
suggestible, passionate, and full of nameless fears !
The nervous schoolboy or schoolgirl prone to
self-analysis, subject-conscious, and easily ex-
hausted ! And how many and how various are
the manifestations of this temperament ! Refusal
of food, refusal of sleep, negativism, irritability,
and violent fits of temper, vomiting, diarrhoea,
morbid flushing and blushing, habit spasms,
phobias — all controlled not by reproof or by

196 THE NERVOUS CHILD

medicine, but by good management and a clear
understanding of their nature.

The hygiene of the child's mind is as important
as the hygiene of his body, and both are studies
proper for the doctor. Neuropathy and an unsound,
nervous organisation are often enough legacies from
the nervous disorders of childhood.

INDEX

Abdomen, prominent, 151
Abdominal symptoms of neurosis,

153
Accent, local, facility with which

acquired, 17
Acetone, in breath and urine during

cyclic vomiting, 86
Acidosis, accompanying cyclic

vomiting, 85

Action, imitativeness of, 19
liberty of, in early childhood,

22

Activities in the nursery, 98
not to be restrained, 23, 24, 98
without intervention of grown-
up people, 99
wonderful nature of, 24
Adenoid vegetations, night-terrors

aggravated by, 136
removal of, in treatment of en-

uresis, 93
Adolescence, and education on

sexual matters, 169, 175
Adults, child in relation to the

society of, 36, 38
Esthetic sense, in early childhood,

48

Affection, in the child, 48
Air hunger, in cyclic vomiting,

86
Air swallowing, habitual action of,

79
Albuminuria, associated with faulty

posture, 152

cause of, in neuropaths, 152
ullimentary disturbances, symptom

of, 157

Alkali, in treatment of cyclic vomit-
ing, 87

Anaemia, of neuropaths, 152
Anorexia nervosa, 50
Acase ilstrating, 50

Apncea, fatal cases of, 83

following burst of crying, 82
twitching of facial muscles in, 83
Appetite, emotional states affecting,

52

loss of, 51
case illustrating, 51
causes and characteristics, 56,

62

treatment, 62
means of stimulating, 53
nature of the sensation of, 52
Apprehension, causes of, 28
growth of neuroses in atmosphere

of, 75

Artificial feeding, 109, 113
Aspirin, 71

Asthma, treatment of, 166
Attention, child's love of attracting,

32, 35, 59
examples of, 33, 39
Authority, delight in defying, 43-

46

over-exercise of, by parents, re-
sults of, 42, 43, 45

Babies. See Newborn Baby
Backward development, 56, 146

signs of, 56
" Bad form," 183
Bad habits, 77-80
Bath, baby's first experience of,

105, 106
Bed, dislike of, 28

how overcome, 28, 29
efforts to resist preparation for,

64, 65, 66
Bedroom, airing and temperature

of, 69
Bedtime, 64, 66

management at, 65, 66
Bed wetting. See Enuresis

191

INDEX

Behaviour. See Conduct
Bladder, hydrostatic distension of,

for enuresis, 92, 93
Boarding-schools, object of, 183
Bodily ailments, and instability of
nervous control, connection
between, 120
See also Disorders
Body, and mind, development of,

120, 121
development of, 146

environment influencing, 5
effect of mind on, 51
gradual alterations in the shape

of, 146
infantile characteristics in later

childhood, 145, 146
Bone, and muscle, changes in, in

infantile children, 148
Books, child's attitude towards,

99

educative value of, 99, 100
kinds most suitable, 99, 100
Brachial nerve, pressure causing

tetany, 81

Breast-feeding, best time for, 109
causes of failure in, 108
observations on, 106
See also Lactation
Breath-holding, 81, 82
action during, 84
fatal cases of, 83
phenomena of, 82
Bromides, administration of, 71
to newborn baby, 110, 111

Cajoling, futility of, 26

Calcium bromide, in treatment ol

spasms, 84
Calcium metabolism, disturbance

of, 82

Care, ill effects of excess of, 163
Carpo-pedal spasm, 81
Catarrhal infections, 155
connection of rheumatism with,

155

Cerebral anaemia, 140
Cerebral circulation, stagnation of,

140
Cerebral exhaustion. See Menta!

Exhaustion

Cerebral functions, rapid growth

of, 5

unstable in the child, 6
See also Mental
Character, formation of, 126

during school life, 184, 186
home influence in the develop-
ment of, 182, 185, 186
ideals of, how inculcated, 125
Children's parties, disadvantages

of, 102
Chloral, administration of, 71

to newborn baby, 110, 111
in treatment of spasms, 84
Chorea, 155

and rheumatism, association be-
tween, 155
symptom of cerebral irritability,

156

treatment of, 156
Chvostek's sign, characteristics and

nature of, 81
Circulation, cerebral, stagnation of,

140

nervous control of, 140
Claustrophobia, 180
Clothing, kind suitable, 69

new, child's delight in, 48
Coaxing, 67

futility of, 26
Cold douches, improving vasomotor

tone, 154

Coldness of extremities, 141
Conduct, control of, factors in, 33,

129
errors of, and sexual instincts,

176

control of, 39
correction of, 127
due to faults of management,

127

in neuropathic children, 126
excessive introspection influenc-
ing, 139

ideals of, how inculcated, 125
influence of environment on, 131
influenced by suggestion, 13
mother's influence on, 11
of neuropaths, 132, 133
perverse, 45
suggestion in the control of, 130

INDEX

193

Constipation, 12

mental causes of, 30, 80
negativism in, 80
perversion of suggestion a com-
mon cause of, 30
suggestion in relation to, 80
Constitution, delicacy of, 161
Convulsions, fatal cases of, 83

generalised, 81

Convulsive disorders, 149, 150
Cough, nervous, 73
Counter-opposition, child's opposi-
tion growing with, 60, 67,
179

Crying, constant, 54, 67
formation of habit of, 115
in emotional and excitable

children, 82
management of, 68
mechanism of, 149
phenomena of, 67
purposeful, 68

Cyclic or periodic vomiting. See
Vomiting

Day - dreams, indicating nervous

temperament, 137
Deceit, 123, 124
Defsecation, inhibition of, 11, 12,

13

painful, 2

Delicacy of constitution, 161
Delirium, tendency to, 161, 162
Depolarisation of ideas, 172
Depression, recurrence of periods

of, 61
Dexterity, lack of, 56

manual, advantages of, 122
toys developing, 96
Diaphragm, spasm of, 82
Diarrhoea, mucous, 142
Diet, likes and dislikes for articles

of, 25

opposition to, 25
of newborn child, changes in,

113

See also Food

Digestion, emotional states affect-
ing, 52, 53

Digestive disorders, mental causes
of, 51, 52, 62

13

Digestive neuroses, 50
Digestive system, symptoms of ex-
treme sensibility of, 141
Dirt eating, 80
Discipline, 43

in later childhood, 118

in the school, 183

misdirected efforts at enforcing,
44

severe, effects of, 119
Dishonesty, 127
Disobedience, 43, 45

growth of, 42

habit of, 59

personality and, 58

perverse attitude of, 34

reproof and coaxing causing,

61
Disorders, aetiology of, 14

associated with neurosis, 145

common, 140-141

environment as cause and cure
of, 142

of neuropaths, 145-159

treatment of, 142

trifling, 162 _
Diuresis, excessive, 141
Doll, child's care of, an example of
imitativeness, 23

educative value of, 98
Douches, cold, improving vasomotor

tone, 154

Dover's powder, 72
Dreams, 70

nature of, indicating nature of

mental unrest, 137
Drugs, in sleeplessness, 70, 71
Ductless glands, in relation to in-
fantile characteristics, 147
Dullards, 149
Dyspepsia, complications of, 54

course and effects of, 54

mental aspects of, 53

nervous symptoms of, 53, 54

symptoms in newborn infant,
116

treatment, 63

Early childhood, care during, 105
impulse of opposition in, 35
love of power in, 32, 86

194

INDEX

Early childhood, nervousness in,

104

reasoning power in, 40
three common neuroses of, 74
toys, books, and amusements in,

96

See also Newborn Baby

Education, aim of, 118-120

by games and toys, 96

on sexual matters, 169

Educative value, of books, games,

and toys, 98-100
Emotional states, appetite affected

by, 52

causing spasm, 83
management of, 82
of neurotics, exaggeration of,

131
physical disturbances due to, 53,

54
producing laryngismus stridulus,

82

Emotional storms, 68
Endocrine glands, 147
Enuresis, 81, 89

causal factors in, 89, 90
characteristics and peculiarities

of, 90-92

condition of urine during, 93
mental aspects of, 95
mistakes in treatment of, 94
perversion of suggestion as cause

of, 89

removal of tonsils in, 92, 93
treatment, essentials in, 94
hypnotic suggestion in, 95
methods of, 92-93
Environment, body moulded and

shaped by, 5

change of, beneficial effects of, 13
effect in developing child's

powers, 22

effect on common disorders, 142
errors of, and neuropathic chil-
dren, 126
essentials of, 39

faulty contact with, in neuro-
pathic children, 138
for neuropaths, 132
influence on conduct in later

childhood, 131

Environment, influence on mental

processes, 10

influence on personality, 24, 25
irritating nature of the adult

mind in, 36, 38
of the home, reflected in the

child, 182

of school life, 183-186
stimulus of, 22
susceptibility to influences of, 25,

31

Epilepsy, cyclical character of, 61
Evil, inborn disposition to, 130
Excitable children, management of,

82

Exercise, sleep in relation to, 69
Exhaustion. See Mental Exhaus-
tion
Expostulation, frequent, bad effects

of, 124, 125
See also Reproof

Expressions, to attract attention,
39

Facial muscles, twitching of, 81
associated with apncea, 83
Faeces, incontinence of, 92
Fainting fits, 140

cause and characteristics, 140
control of, 141
of neuropaths, 152
Fatigue, mental, physical, and vis-
ceral, 143

Fats, lowered tolerance to, 87
Faults, correction of, 127
not corrected by too frequent

reproof, 124, 125
Fear, 39
causes of, 28
phenomena of, 134, 135
prominent psychical symptom of
neuropathic children, 132,
133

treatment of, 135
Feeding, 55

artificial, 109, 113
factors in, 57, 58
of newborn infant, regularity [in,
116 ^

Fertilisation, method of imparting
knowledge of, 174

INDEX

195

Food, force of suggestion in relation

to, 25-27

healthy desire for, 62
likes and dislikes for, 25

how overcome, 26
phenomena of the desire of, 52
refusal of, 35, 50
nervous causes of, 52
persistent, factors encouraging,

57
suggestion in relation to, 57,

58

treatment of, 26, 55, 62
Force and cajoling, futility of, 26
Freud, teaching of, 176
Functional disturbances, in com-
bination with organic dis-
ease, 4

Gait, peculiarity of, 74

Games, educative value of, 96, 98

Gastric disturbances, 54

Gastric juice, psychic secretion of,

52

Gastric symptoms, of neurosis, 153
Gastro -intestinal derangement,

causes of, 141
environment as cause and cure of,

142
Gentleness, 119

inculcation of, 129
Girls' schools, 188
Glottis, spasm of, strong emotion

causing, 82

"Good form," 183, 184
Grasping habit, reproof in relation

to, 21
Growing pains, 167

Habit spasms, age of appearance of,

cause of, 74

definition of, 73

examples of, 73

spread of, 75

suggestion in relation to, 74

treatment of, 76
Habits, regulation of, 30

suggestion in relation to, 30
Habitual actions, infant's pleasure
in, 77

Habitual actions, mental unrest in

relation to, 77
of the parent, reproduction in

the child, 75

varieties and characteristics, 77
Habitual wake fulness, 70
Hands, control of movement of, 19,

22

expressionless, 56

Happiness and contentment, of

child when playing alone, 96

Headache, periodic. See Migraine

Heat and cold, newborn baby in

relation to, 106

Heat and flushing, sudden sensa-
tions of, 141

Heredity, and temperament, 10
and type of child, 31
nervous disorders in relation to, 5
Home influence, in development of

character, 182, 185, 186
reflected in the child, 182
Hunger, of the newborn baby, 105,

109
Hypnotic suggestion, in treatment

of enuresis, 95
Hypnotics, 70, 71
Hysteria, 158

age of appearance of, 158
suggestion in relation to, 32
symptoms of, 158
Hysterical girls, characteristics of,
32

Ideals, inculcation of, 118-119
Ideas, polarisation and depolarisa-

tion of, 172
Illness. See Sickness
Imagination, abnormal, correction

of, 138
child's stories and tales in relation

to, 137, 138
developed by toys, 98
Imitativeness, age at which ap-

• parent, 16
extent of, 23
illustration of, 17, 23
lack of, 56
of action, 19
of speech, 17, 18
tell-tale child an illustration of, 18

196

INDEX

Incontinence of urine, 89-95
Incorrigible children, 129
Infantile characteristics, 146
ductless glands in relation to,

147
nervous system in relation to,

149, 150
Infective disorders, convalescence

from, 157
producing nervous symptoms,

167

relation of neurosis to, 167
Inflammatory reactions, 147
Insomnia. See Sleeplessness
Intellect, compared with physique,

120
Intelligence, in early childhood,

40, 41, 42

Intestinal disturbance, 54
of neurosis, 153
symptom of, 157
Intoxications, violent reaction to,

142
Introspection, and neuropathic

children, 138

excessive, evidences of, 139
influencing conduct, 139
Irritation, child to be free from, 40

Joint pains, 167

Kindergarten school, artificial sym-
bolism of, 24
Kindness, inculcation of, 129

Lactation, care of child during, 106,

109

care of mother during, 110
causes of failure in, 108
establishment of, 106, 107
tongue-tie in relation to, 12

Laryngismus stridulus. See Breath-
holding

Later childhood, infantile charac-
teristics in, 146
management in, 117-130
mental backwardness in, 146

Likes and dislikes, 25

Lordosis, 151
and neurosis, 151
producing albuminuria, 152

Manual dexterity, advantages of,

122
Massage, improving tone of muscles,

154

Medicines, sensitiveness to, 26
Melancholy children, 157
Mental aspects, of digestive dis-
orders, 51-54
of enuresis, 95

of management in early child-
hood, 31
Mental backwardness, and infantile

characteristics, 146
in later childhood, 146
Mental disturbances, cyclical char-
acter of, 61

indicating neuropathic ten-
dencies, 132, 133
irregularities of sleep due to, 68
psycho-analysis of, 177, 178
Mental exhaustion, during con-
valescence from infective
disorders, 157
easily produced in nervous

children, 143
Mental irritability, chorea a

symptom of, 156
Mental life of the child, 101
Mental power, active before begin-
ning of speech, 40
in early childhood, 40
Mental processes, development of,

5, 22, 23, 50
age at which most apparent,

16

in later childhood, 117
effect of unconscious suggestions

on, 29

heredity in relation to, 10
influence of environment on, 10,

22
Mental training, 122

compared with physical training,

120
objects and advantages of, 122,

126

Mental unrest, avoidance of, 67
crying in relation to, 67
digestive disturbances due to, 62
growth of neuroses in atmosphere
of, 75

INDEX

197

Mental unrest, habitual actions in

relation to, 77
in the adult, 7
in the child, 6, 7
negativism due to, 60
of newborn infant, effects of, 107
See also Nervous Unrest
Micturition, functional disorder of,

30

negativism in, 81
regulation of, 30
See also Enuresis

Migraine, periodic vomiting as-
sociated with, 85
symptom of nervous exhaustion,

87
Mind, and body, development of,

120, 121

effect on the body, 51
vigour of, in relation to that of

body, 120

Money, theft of, 127
Montessori system of training, 20,

23, 121

Moral degeneracy, 126
Moral standard of school life, 183
Moral training, 123

importance and effects of, 120
negative virtues and, 124
objects and advantages of, 123,

126
parents' responsibilities in, 123,

124
Morals, public opinion forming

code of, 183

Morbid introspection, 139
Mothers, ability and inability to

manage children, 8
attitude in regard to tempera-
ment of child, 10, 11
care of, during lactation, 110
conduct of child influenced by,

11
inability to understand nature of

child's disorders, 5
influence of, on tone and manner

of speech, 17
mental environment of child

created by, 8
personality of, 7
relation to the child, 101

Motionless children, 157
Mouth, habit of conveying every-
thing to, cause of, 19
Movements, precision of, 20
purposive, development of, 19,

21

self-command of, 21
Muscular atrophy, and neurosis,

151

Muscular system, changes in in-
fantile children, 148
weak development of, 151
Muscular tone, how improved, 154
Myopathy, primary, 151

Nasal obstruction and failure of

lactation, 12, 108
night- terrors aggravated by, 136
Natural history, sexual matters

taught by, 174
Naughtiness, child's delight in,

45

Naughty, use of the term, 44
Negative virtues, and moral train-
ing, 124

Negativism, 3, 12, 13
cause of, 60, 61
characteristics, 50
factors developing, 56
in constipation, 80
in micturition, 81
spirit of, 45
treatment of, 60
want of sleep depending on,

64

Nerve centres, controlling move-
ment, development of, 21
Nervous control, instability of, con-
nection between bodily ail-
ments and, 120
Nervous cough, 73
Nervous disorders, and psycho-
analysis, 177, 178
common, causes, characteristics,

and treatment, 140-142
frequency of, 50

Nervous exhaustion, cyclic vomit-
ing and migraine symptoms
of, 87

Nervous instability, stigma of, 140-
142

198

INDEX

Nervous system, abnormal in

children, 149

in relation to cyclic vomiting, 85
increased irritability of, 81
infantile characteristics of, 149
Nervous unrest, environment in

relation to, 142
factors increasing, 61
manifestations of, 73
recurrence of periods of, 61
symptoms of, 6, 7
See also Mental Unrest
Nervous vomiting. See Vomiting
Nervousness, and digestive dis-
orders, 53, 54
and neuropathy, 132-135
in early infancy, 104
in older children, 131-144
parents' attitude causing, 31
Nettlerash, 161
Neurasthenia, 157
Neuropathic children, common

symptoms of, 140-144
conduct of, 133
faulty contact with environment

in, 138
fear the prominent symptom of,

133

introspection and self-conscious-
ness of, 138
management of, 150
training of, 1 26
Neuropathic tendencies, evidence

of, in older children, 133
Neuropaths, adult, 143

faulty management in child life

leading to, 2, 14
phenomena of, 132
phobias of, 143

selection of suitable environ-
ment for, 132, 133
symptoms of, 7
Neuroses, and psycho-analysis, 177,

180
association of albuminuria with,

153
constipation frequently due to,

80

examination of, 82
growth in atmosphere of unrest
and apprehension, 75

Neuroses, relation of, to infection

of the body, 167
treatment of, 153
Neurotics, and physique, 145, 151
characteristics, 131, 132
exaggeration of emotions of, 131
Newborn baby, administration of

sedatives to, 110
artificial feeding of, 109, 113
breast feeding of, 106, 107
case of, 105, 109, 114, 115
effect of mental unrest on, 107
first impressions of, 104
formation of habits of sleep and

crying in, 115
heat and cold in relation to,

106

hunger of, 105, 109
induction of the sucking move-
ments of, 106
of nervous inheritance, 105
personality of, 104
prevention of restlessness and

crying, 114, 115
reduction of sense stimuli in,

105

reflex action of sucking in, 108
sense of taste of, 113
symptoms of dyspepsia in, 116
times of feeding, 116
weaning of, 113, 114
Night-terrors, aggravation of, 70,

136

causes of, 135

of neuropathic children, 134
Nursery, activities in, child's

interest in, 22-23
importance of child's being alone

in, 36, 38, 96, 99, 101
observations in, 16
Nursery life, advantages of, 9
Nursery psycho-therapeutics, 15
Nurses, ability and inability to

manage children, 9
influence of, on tone and manner

of speech, 17
mental environment of child

created by, 8
personality of, 7
Nursing, during sickness, 166
of the newborn infant, 105-115

INDEX

199

Obedience, 49

and perverse pleasure, 34
growth of, 42

Obsession of bed wetting, 89, 91
Opposition, 61

and counter-opposition, 67, 179

during sickness, 160

force of, factors influencing

development, 60
habit of, 59
impulse of, 35
love of, in early childhood, 59,

60

to food, 25

Organic disturbance, in combina-
tion with functional trouble,
4

Pain, frequent loss of sense of, in

neuropaths, 138, 139
Pallor, 152

sudden attacks of, 141
Palpitation, example of visceral

fatigue, 143
Parathyroid glands, function of,

147
Parents, and children, conflict

between, 43, 44
and silence on sexual matters,

170
habitual actions of, reproduced

in the child, 75
mental attitude of, in relation

to conduct, 31
over-exercise of authority by,

results of, 42, 43, 45
responsibilities in moral training

of child, 123, 124
suggestions unconsciously con-
veyed by, evil results of,
31, 164/166

Parties, disadvantages of, 102
Patient, temperament of, physician

in relation to, 4
Pelvis, development of, 146
Peripheral nerves, increase in ir-
ritability and conductivity
of, 81 "

Personal adornment, delight in, 48
Personality, and disobedience, 58
child's own conception of, 24, 129

Personality, environment influenc-
ing, 25

in early childhood, 32, 165
of newborn baby, 104
Perspiration, abundant, sudden

attacks of, 141
Phobias, 14
characteristics and varieties, 134,

135

frequency of, 134
treatment of, 135
Physical defects, accompanying

neurosis, 145, 151
Physical disturbances, due to

emotion, 53, 54
Physical exercise, lack of, causing

want of sleep, 69
Physical fatigue, easily produced in

nervous children, 143
Physical phenomena of neuropaths,

132
Physical training, 121

objects and advantages of, 121,

122, 126
Physician, and the temperament of

his patient, 4
examination by, 2, 3, 13
diagnosis by, 2, 3, 13
difficulties of, 4
Physique, intellect compared with,

120

Pica and dirt eating, 80
Picture books, educative value of,

100

kinds most suitable, 99, 100
Play, happiness of child during, 96
in the nursery, 36, 37
with grown-up persons, 36, 38
Pleasure, sense of, in early child-
hood, 48

Polarisation of ideas, 172
Postural albuminuria, 152
Posture, faulty, 161, 162

prevention of, 154
Power, child's love of, 32, 59
Precision of movement, develop-
ment of, 19, 96
Psycho-analysis, dangers of, 180

observations on, 176, 177
Public schools, character and effects
of, 183

200

INDEX

Punishment, deserved and unde-
served, 126

frequent, disadvantages of, 47
observations on, 39, 46
Purity, inculcation of high ideals

of, 175
Purposive movements, earliest,

cause of, 19
encouragement of, 24
Pyloric spasm, 112
Pyrexia, 88

organic disease in relation to, 88

Rational hygiene, 5
Reasoning power, 40

active before advent of speech,

40
factors influencing development

of, 40, 41, 117, 118
Regulation of habits, 30
Repression, by older children of

younger, 47
Reproduction, method of imparting

knowledge of, 174
Reproof, 20, 21, 24
cases in which useless, 60, 124
causing disobedience, 61, 124
effects of, 33, 36, 47, 124
extreme sensitiveness to, 46
perverse pleasure of, 34
too frequent repetition of, futility
of, 44, 45, 47, 60, 124,
125

Restlessness, during sickness, 160
Rewards, use and dangers of, 48
Rheumatism, 155
and chorea, association between,

155

characteristics in childhood, 156
subacute, 167
treatment of, 156
Rickets, mental and intellectual

condition in, 120
in infantile children, 148
occurrence with spasmophilia, 82
Right and wrong, appreciation of,

in early childhood, 42
Round shoulders, 151

St. Vitus's dance, 167
Salts, excretion of, 147

School life, 182, 184
and sexual matters, 171, 175
moral standard of, 183
moral training and, 123
moulding of character during,

184

of boys, 183-187
of girls, 188
Schools, public, character and

effects of, 183
Scoliosis, prevention of, 154
Secretions, anomalies of, 141
Self, child's conception of, 48
Self-conscious children, complaints

of, 139
Self-consciousness, of neuropathic

children, 138
Self- discipline, development of,

125, 126

Self-education, in the nursery, 96
Self-feeding, 55
Self-preservation, morbid instinct

of, 134
Self-sacrifice, not to be expected in

early childhood, 48-49
Sensations, acuteness of, 69
bodily, of neuropaths, 138
Sense perception, of neuropaths,

132

Sense stimuli, cultivation of per-
ception of, 23
in newborn babies, 105
Sexual matters, education on, 168

method of, 174
errors of conduct and, 176
parents' silence in regard to, 170
psycho-analysis in relation to,

177, 178

school life in relation to, 171, 175
Sickness, 160

evil effects of suggestions un-
consciously conveyed by
parents during, 164, 166
management during, 160, 163
nurse and mother during, 166
opposition during, 160
temperature during, 161
therapeutic measures in, 164
therapeutic procedures concen-
trating child's mind on his
symptoms, 163

INDEX

201

Sleep, estimation of the amount of,

136
force of suggestion in relation to,

27,28

formation of habit of, 115
light and broken, cause of, 68,

136, 137

of newborn infant, 114
sound, beneficial effects of, 71
Sleeping attire, 69
Sleeplessness, breaking of the

habit of, 70

causes and characteristics, 64
drugs in, 70, 71
in older children, 136
lack of physical exercise causing,

69
suggestion in relation to, 27, 28,

70

treatment of, 67, 70, 137
Sleep-walking, 137
Snatching, habit of, 20
Spasmophilia, 81
aetiology of, 81
drugs in treatment of, 84
occurrence of rickets with, 82
Spasms, control of, 84

fatal, 83

Speech, beginnings of, 17, 18
facility with which local accent

is acquired, 17
imitativeness of, 17, 18
infant's reasoning power present

before advent of, 40
influence of nurses and mothers

on tone and manner of, 17
Spinal deformity, prevention of,

154

Spinal muscles, atrophy of, 151
Spoon feeding, 113
Status catarrhalis, 150
Status lymphaticus, 150
Story-telling, 99, 100
Sucking movements, of newborn

child, induction of, 106
See also Lactation
Suggestion, and habit spasms, 74
appetite in relation to, 52
bed wetting in relation to, 89
bodily habits in relation to, 30
characteristics, 24

14

Suggestion, conduct influenced by,

18, 130

constipation in relation to, 80
effect on mental processes, 29
food in relation to, 25
force of, on child's mind, 27,

75

hysteria in relation to, 32
perverse influence of, 29, 30
bad habits due to, 89, 90
causing constipation, 30
want of sleep depending upon,

64
refusal of food in relation to, 57,

58

sleep in relation to, 27
susceptibility to, 29, 57
unconsciously conveyed by
parents, evil results of, 31,
164, 166
Suicide, 52
Suspicions, aroused in the child, 57,

58

Syncopal attacks, causes and
characteristics, 140, 141

Tactile sensation. See Touch
Taste, perversion of, 26, 57
sensations of, 25

how controlled, 26
sense of, in newborn infant,

113

Teething convulsions, 148
Tell-tale child, characteristics, 18
Temperament, diversity of, 10
heredity and, 10
mother s attitude in relation to,

10, 11

of the patient, physician in rela-
tion to, 4
Temperature, during sickness, 161

inexplicable rises in, 88
Terror, causes, of, 28
Tetany, liability to, in increased
irritability of nervous sys-
tem, 81

pressure to brachial nerve caus-
ing, 81

Theatres, disadvantages of, 103
Theft, 52, 127
Therapeutic conversation, 124, 125

202

INDEX

Thigh rubbing, avoidance of, 78

characteristics, 78

habitual action of, 78
Thorax, development of, 146
Thumb sucking, 78, 79

persistence of the habit, 79
Tongue-tie, in relation to lactation,

12

Tonics, 155
Tonsils, removal of, in treatment of

enuresis, 93
Touch, sense of, cultivation of, 23

early development of, 19, 20

organs with greatest develop-
ment of, 19
Toys, child's interest in, 36

educative value of, 96, 98

kind most suitable, 97
Training, early, importance and

object of, 2

Trousseau's sign, nature and pro-
duction of, 81
Truthfulness, 123, 124

inculcation of, 128
Twitching of facial muscles, 81, 83
Tyranny of tears, 116

Unkindness, habitual, of children

to others, 129
Untruthfulness, 126

over-exercise of authority en-
couraging, 43

Urine, condition in enuresis, 93
incontinence of, methods of treat-
ment, 92, 93
See also Enuresis
increased secretion of, 141
irritation of, 148

Vasomotor instability, conditions

indicating, 140, 141
in neuropaths, 152
Vasomotor tone, how improved,

154
Virtuous, definition of the term,

183
Visceral fatigue, easily produced in

nervous children, 143
Vocabulary, 18
Voice, tone of, 17

Voluntary movements, develop-
ment of cerebral centres
controlling, 19
Vomiting, cyclic, 50, 55
aetiology of, 85
age at which it occurs, 86
case illustrating, 51
causes and characteristics, 62,

86

class of child affected by, 87
condition of the child during,

86

frequency of attacks, 86
migraine in association with,

85
nervous system in relation to, 86,

87
treatment of, 62, 63, 87

Waking states, 136

Weaning, difficulty in, 113, 114

Will, strength of, absence in child-
hood, 34

Work and play, differentiation
between, 123

Writing, correct posture during,
155

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